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Introduction The global coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus began in Wuhan, China, in December 2019, and it has affected over 4.4 million people worldwide, with 302,169 deaths as of May 16, 2020. 1 Though respiratory symptoms are the most common presentation of COVID-19, cardiac involvement is a prominent feature of this disease, occurring in 20% to 30% of hospitalized patients and contributing to 40% of deaths. 2-4 COVID-19-related [...]

RESUMO Introducao O stent MGuard™, revestido por malha polimerica microscopica, tem a finalidade de reduzir a embolizacao distal de fragmentos durante a intervencao coronaria percutânea (ICP) em enxertos de veia safena (EVS). Avaliamos os desfechos clinicos precoces e tardios de pacientes submetidos a ICP de EVS com stents MGuard™ vs. stents farmacologicos (SF). Metodos Estudo observacional, retrospectivo, realizado em dois centros terciarios, envolvendo uma coorte de pacientes com lesoes em EVS, tratados de forma eletiva ou de emergencia com stents MGuard™ ou SF. Resultados Foram incluidos 271 pacientes, sendo 220 tratados com SF. O Grupo MGuard™ apresentou maior proporcao de mulheres (25,5% vs. 10,5%; p=0,01), com media de idades de 65,0 ± 13,9 anos vs. 69,0 ± 9,6 anos (p = 0,06). O Grupo SF utilizou com maior frequencia filtro de protecao distal (5,8% vs. 10,0%; p = 0,001). Sucesso angiografico foi obtido na maioria dos casos (96,2% vs. 98,0%; p = 0,22). O Grupo MGuard™ teve menores taxas de eventos cardiovasculares adversos maiores (ECAM) na fase hospitalar que o Grupo SF (1,9% vs. 13,6%; p = 0,01) devido exclusivamente a menor incidencia de infarto periprocedimento. Entretanto, a taxa de ECAM em 1 ano foi maior no grupo MGuard™ (14,3% vs. 4,4%; p = 0,01) a custa de maior taxa de revascularizacao da lesao alvo (7,1% vs. 1,3%; p = 0,048). Conclusoes A utilizacao de stent MGuard™ resultou em reducao de eventos na fase hospitalar, porem, no longo prazo, os SF foram superiores em reduzir desfechos maiores, sobretudo a necessidade de revascularizacao da lesao alvo.

RESUMOIntroduçãoA revascularização miocárdica anatômica completa está associada a um melhor controle dos sintomas anginosos e a menores índices de eventos cardíacos maiores tardios. No entanto, em substancial número de pacientes tratados por meio de intervenção coronária percutânea (ICP), não logramos sua obtenção. Assim, nosso objetivo foi avaliar os fatores associados à revascularização miocárdica incompleta (RMI) em casos de ICP multiarterial.MétodosEstudo de coorte envolvendo 1.049 pacientes revascularizados de forma prospectiva e consecutiva por meio de ICP com tratamento de dois ou mais vasos, entre 2012 e 2014, divididos em dois grupos: RMI (n=324; 30,9%) e revascularização miocárdica completa (n=725; 69,1%).ResultadosA RMI foi significativamente associada a faixa etária maior (66,5 anos vs. 64,1 anos; p=0,003), hipertensão arterial (92,2% vs. 86,0%; p=0,006), insuficiência renal crônica (36.4% vs. 26.0%; p < 0,001), síndrome coronariana aguda (26,3% vs. 21,0%; p=0,05), revascularização cirúrgica prévia (16,1% vs. 7,1%; p=0,001), lesões em enxertos venosos (3,4% vs. 1,0%; p < 0,001) e oclusões crônicas (3,3% vs. 1,4%; p=0,005), bem como a menor acesso a stents farmacológicos (57,8% vs. 64,8%; p=0,002). Os resultados clínicos hospitalares não diferiram entre os grupos.ConclusõesA RMI ocorreu em cerca de um terço dos casos tratados, tendo sido observada associação significativa, com um perfil clínico de maior risco e com intervenções em lesões alvo comumente associadas com menor sucesso do procedimento. O grau de revascularização não gerou impacto nos resultados clínicos da fase hospitalar.ABSTRACTBackgroundComplete anatomical myocardial revascularization is associated with better angina control and lower rates of cardiac events. However, in a significant number of patients treated by percutaneous coronary intervention (PCI), complete revascularization is not achieved. Thus, the aim of this study was to evaluate factors associated with incomplete myocardial revascularization (IMR) in multivessel PCI patients.MethodsThis was a cohort study involving 1,049 prospectively and consecutively revascularized patients through PCI with treatment of two or more vessels, between 2012 and 2014, divided into two groups: IMR (n=324; 30.9%) and complete myocardial revascularization (n=725; 69.1%).ResultsIMR was significantly associated with older age (66.5 years vs. 64.1 years; p=0.003), arterial hypertension (92.2% vs. 86.0%; p=0.006), chronic renal failure (36.4% vs. 26.0%; p < 0.001), acute coronary syndrome (26.3% vs. 21.0%; p=0.05), previous surgical revascularization (16.1% vs. 7.1%; p=0.001), saphenous venous graft lesions (3.4% vs. 1.0%, p < 0.001), and chronic occlusions (3.3% vs. 1.4%, p=0.005), as well as lower access to drug‐eluting stents (57.8% vs. 64.8%; p=0.002). In‐hospital clinical outcomes did not differ between the groups.ConclusionsIMR occurred in approximately one‐third of treated cases, and a significant association was observed with a higher‐risk clinical profile and with target lesion interventions commonly associated with lower procedure success. The degree of revascularization had no impact on in‐hospital clinical outcomes.

First generation drug-eluting stents (DES) are associated with reduced in-stent restenosis but significant increased risk of very late stent thrombosis (VLST). The absence of polymer in DES systems may reduce the occurrence of VLST. Optic coherence tomography (OCT) has been used for stent analysis as a surrogate safety endpoint. This study aimed to assess the long-term follow up of strut apposition and tissue coverage of BioMatrix DES by OCT. 20 patients undergoing BioMatrix DES (n = 15) or S-Stent BMS (n = 5) implantation were followed for at least 5 years and evaluated by quantitative coronary angiography, intravascular ultrasound, and OCT. The difference between the stent types was evaluated by nonparametric Mann-Whitney U test while categorical variables were evaluated by Fisher exact test. Rates of in-stent late loss were similar between groups [0.40 (0.21;0.77) vs. 0.68 (0.66; 0.82) mm, p = 0.205, for BioMatrix and S-Stent, respectively]. The vessel, stent and lumen volumes did not differ between groups. Patients treated with BioMatrix had significantly less stent obstruction [5.6 (4.4;9.7) vs. 28.6 (24.7;29.0) %, p = 0.001]. OCT analysis of 12 stents (Biomatrix = 9 and S-Stent = 3) demonstrated 126 (8.7 %) uncovered struts in the BioMatrix group compared to 23 (4.0 %) in the S-Stent group (p = 0.297), being the majority of them well apposed (117/126 and 21/23, respectively, p = 0.292). Only 9 (0.6 %) struts in the DES and 2 (0.4 %) struts in the BMS groups were simultaneously uncovered and malapposed (p = 0.924). BioMatrix DES was associated with lower rates of in-stent obstruction, and similar percentage of neointimal coverage on struts and of complete strut apposition.

BackgroundPercutaneous revascularization in diabetic is frequent and the use of drug-eluting stents (DES) is desirable, since they reduce restenosis and the need for repeat revascularization. The objective of this study was to compare the long-term outcomes of diabetic patients treated with and without DES.MethodsA consecutive cohort of diabetic patients undergoing percutaneous coronary intervention (PCI) between January 2009 and December 2012 in a public tertiary hospital was prospectively followed-up.ResultsNine hundred and thirty-nine diabetic patients (38.3%) treated with DES and 580 (61.7%) treated with bare metal stents (BMS) were evaluated. The rate of major adverse cardiac events (MACE) in 12.6±3.4months was greater in the BMS group (9.5% vs. 14.8%; RR, 1.56; 95% CI, 1.07-2.27; P=0.02), as well as death (2.8% vs. 6.7%; RR, 2.41; 95% CI, 1.22-4.77; P

Background: Bioresorbable vascular scaffolds (BVS) were developed to improve the long-term results of percutaneous coronary intervention, restoring vasomotion. Objectives: To report very late follow-up of everolimus-eluting Absorb BVS (Abbott Vascular, Santa Clara, USA) in our center. Methods: Observational retrospective study, in a single Brazilian center, from August 2011 to October 2013, including 49 patients submitted to Absorb BVS implantation. Safety and efficacy outcomes were analyzed in the in-hospital and very late follow-up phases (> 2 years). Results: All 49 patients underwent a minimum follow-up of 2.5 years and a maximum of 4.6 years. Mean age was 56.8 ± 7.6 years, 71.4% of the patients were men, and 26.5% were diabetic. Regarding clinical presentation, the majority (94%) had stable angina or silent ischemia. Device success was achieved in 100% of cases with 96% overall procedure success rate. Major adverse cardiovascular events rate was 4% at 30 days, 8.2% at 1 year, and 12.2% at 2 years, and there were no more events until 4.6 years. There were 2 cases of thrombosis (1 subacute and 1 late). Conclusions: In this preliminary analysis, Absorb BVS showed to be a safe and effective device in the very late follow-up. Establishing the efficacy and safety profiles of these devices in more complex scenarios is necessary. Resumo Fundamento: Os suportes vasculares bioabsorvíveis (SVB) foram desenvolvidos com o intuito de melhorar os resultados da intervenção coronária percutânea a longo prazo, restabelecendo-se a vasomotricidade. Objetivos: Reportar o seguimento muito tardio do implante do SVB eluidor de everolimus Absorb® (Abbot Vascular, Santa Clara, EUA) em nosso centro. Métodos: Estudo observacional, retrospectivo, em um único centro brasileiro, que incluiu 49 pacientes submetidos ao implante do SVB Absorb® entre agosto/2011 e outubro/2013. Foram analisados os desfechos de segurança e eficácia na fase hospitalar e bastante tardia (> 2 anos). Resultados: Todos os 49 pacientes completaram um seguimento mínimo de 2,5 anos, sendo o máximo de 4,6 anos. A média de idade foi 56,8 ± 7,6 anos, sendo 71,4% da população estudada do sexo masculino e 26,5% composta por diabéticos. Considerando a apresentação clínica, a grande maioria (94%) tinha angina estável ou isquemia silenciosa. Obteve-se sucesso do dispositivo em 100% dos casos e do procedimento, em 96%. A taxa de eventos cardiovasculares maiores foi de 4% aos 30 dias, de 8,2% em 1 ano, e de 12,2% em 2 anos, sem mais eventos até 4,6 anos. Houve 2 casos de trombose (1 subaguda e 1 tardia) até o último seguimento. Conclusões: Nesta análise preliminar, o uso do SVB Absorb® mostrou-se seguro e eficaz no seguimento bastante tardio. Faz-se necessário estabelecer o perfil de eficácia e segurança destes dispositivos em cenários de maior complexidade.

Background Lately drug-eluting stents (DES) have dramatically reduced restenosis rates and need for repeat revascularization in a wide subset of lesion and patients. However, their benefit for the treatment of large vessels (>3.0 mm) has yet to be established. Objective We investigated whether DES are superior to bare metal stents (BMS) in terms of clinical outcomes for the treatment of large coronary vessels. Methods This study assessed the long-term outcomes (cardiac death, acute myocardial infarction, and need for repeat intervention in the treated vessel) of patients treated with either a DES (Cypher and Taxus) or a BMS of ≥3.5 mm in diameter. A total of 250 consecutive patients who underwent DES implantation were clinically followed for 1 year and compared to 250 patients who were treated with BMS. Interventions in the setting of acute ST elevation myocardial infarction and treatment of bypass grafts were excluded. Results Cypher was the DES deployed in 70.8% of cases. Most of the enrolled patients were men (78%) with single vessel disease (65.6%). The left anterior descending artery was the culprit vessel in 34.2% of cases. Bare metal stent and DES cohorts had equivalent interpolated reference vessel diameter (3.19 ± 0.3 mm for BMS vs 3.18 ± 0.2 for DES; P = .1). Lesion was significantly longer in the group treated with DES (13.4 ± 5.1 mm for BMS group vs 14.3 ± 3.5 for DES; P = .0018). After 1 year of clinical follow-up, 95.2% of patients treated with DES and 91.2% of the patients who received BMS were free of major events ( P = .2). A trend toward higher target-lesion revascularization was noticed in the group treated with BMS (4.8% vs 1.6%; P = .07). Conclusion Percutaneous treatment of large coronary vessels carries a low risk of clinical events irrespective of the type of stent used.

The ZoMaxx Coronary Stent System elutes the antiproliferative agent zotarolimus via a biocompatible phosphorylcholine polymer loaded onto a novel, thin, stainless steel stent platform containing an 0.0007-inch inner layer of tantalum that enhances fluoroscopic radiopacity. The objective of this single-arm prospective clinical trial was to assess the safety and performance of the ZoMaxx stent for the treatment of coronary artery stenosis. Forty consecutive patients with ischemic coronary occlusive disease due to single de novo obstructive lesions of native coronary arteries were treated with 3 x 18 mm ZoMaxx stents at the Dante Pazzanese de Cardiologie in Saõ Paulo, Brazil, between April and July 2005. Independent core laboratories analyzed quantitative coronary angiography and intravascular ultrasound results immediately after stent implantation, and after 4 months. The lesion, procedure, and device-deployment success rates were all 100% (40 of 40). There were no major adverse cardiac events during the study. Follow-up quantitative coronary angiography at 4 months revealed in-stent and in-segment late lumen losses of 0.20 +/- 0.35 and 0.17 +/- 0.35 mm, respectively. Follow-up intravascular ultrasound at 4 months revealed 6.5 +/- 6.2% neointimal volume obstruction. There were no instances of late acquired stent incomplete apposition or stent thrombosis. In conclusion, the ZoMaxx Coronary Stent can be safely implanted for the treatment of de novo coronary artery stenosis. The inhibition of neointima formation as measured by follow-up angiography and IVUS after 4 months suggests therapeutic potential for the reduction of restenosis.

We report the outcomes of patients who had in-stent restenosis (IRS) that was treated with intravascular brachytherapy (IVBT) or sirolimus-eluting stent (SES) implantation. The benefit of IVBT for treating ISR is well documented. SES implantation decreases first-time ISR and, in preliminary reports, has been used to treat ISR. Fifty consecutive patients who had ISR were treated; the first 25 patients underwent SES implantation and the next 25 patients were treated with IVBT using a beta-Cath System (a 40-mm strontium-90/yttrium-90 source). Quantitative angiographic and intravascular ultrasound follow-up were performed at 5.2 +/- 1.1 and 12.1 +/- 1.2 months; clinical follow-up was performed at 15 months. SES deployment and IVBT were successful in all patients. At 12-month follow-up, 8 patients who underwent IVBT had angiographic recurrence (4 in the stent and 4 at the stent edge); only 1 patient who underwent SES implantation developed recurrent ISR. At 12 months, in-stent late luminal loss was similar between the SES and IVBT groups (0.35 +/- 0.45 vs 0.34 +/- 0.46 mm, p = 0.9); however, in-stent net luminal gain was higher in the SES group than in the IVBT group (1.32 +/- 0.13 vs 0.57 +/- 0.19 mm, p

We performed serial intravascular ultrasound analysis in patients who underwent balloon dilatation for in-stent restenosis. Early lumen loss was detected by intravascular ultrasound and was associated with minimal changes at the edges and at the external elastic membrane. These results on intravascular ultrasound suggest compression and decompression as the main mechanisms for early lumen loss after dilatation of in-stent restenotic lesions.

). The patients were followed up to determine the rate of major cardiac events (MCE) in 2 years, the need for revascularization of the target lesion, and to identify the clinical, angiographic, and ultrasound predictors of events. Results Seventy-five (43%) patients had MLA ≥ 4.0 mm 2 and were clinically treated; 98 (57%) patients had MLA < 4.0 mm 2 and ; P < 0.001)). The clinical impact of the decision was favorable, and no difference was observed in regard to the occurrence of major cardiac events: (group 1: 5 (7%) vs group 2: 14 (15%); P = 0.09). The need for revasculari- zation of the target lesion also did not differ (group 1: 3 (4%) vs group 2: 11 (12%); P = 0.07). The predictive variables for MCE were diabetes, functional class III (FC III) angina before hospitali- zation, and MLA assessed on ultrasound. Conclusion This strategy for deciding on appropriate treatment guarantees low rates of MCE in both groups in the 24-month follow-up, with reduced revascularization rates. The predictive variables of major cardiac events were as follows: diabetes mellitus, FC III angina, and MLA on intravascular ultrasound.

OBJECTIVE:To verify the influence of moderate- or high-pressure balloon inflation during primary coronary stent implantation for acute myocardial infarction. METHODS: After successful coronary stent implantation, 82 patients were divided into 2 groups according to the last balloon inflation pressure: group 1 (superscript three12 to superscript three16 to 20 atm), each with 41 cases. All patients underwent late coronary angiography. RESULTS: In group 1, the mean stent deployment pressure was 13.58±0.92 atm, and in the group 2 it was 18.15±1.66 atm. Stents implanted with moderate pressures (superscript three12 to superscript three16 atm) did not cause a measurable improvement in late outcome, either in the late loss, its index, and the net gain, or in clinical and angiographic restenosis rates.

he FREEDOM study, recently presented at American Heart Association (AHA) congress in November 2012 and simultaneously published in the presti­gious New England Journal of Medicine, demonstrated that myocardial revascularisation surgery provides better results than percutaneous coronary intervention (PCI) with drug­eluting stents (DES) for the treatment of diabetic patients with complex coronary artery disease. In this international multicenter study involving 140 hospitals, of which four are located in Brazil (Instituto Dante Pazzanese de Cardiologia – Sao Paulo, SP; Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo – Sao Paulo, SP; Hospital Universitario da Pontificia Universidade Catolica de Porto Alegre – Porto Alegre, RS; and Hospital Cardiologico Costantini – Curitiba, PR), 1,900 diabetic patients with multivessel involvement and no lesions in the left main coronary artery were randomized to coronary artery bypass graft (CABG) surgery or PCI procedures.

Stent thrombosis (ST) is an infrequent event following 2nd generation drug-eluting stents (DES); however, its occurrence may be catastrophic. Our objective was to report the incidence of ST in a large population treated with Endeavor zotarolimus-eluting stents (E-ZES) and randomized to short- (3

Background Our aims were to compare coronary artery bypass grafting (CABG) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study (ARTS) trial and to determine the costs of these 2 treatment strategies. Methods and Results Patients (n=1205) were randomly assigned to stent implantation (n=600; diabetic, 112) or CABG (n=605; diabetic, 96). Costs per patient were calculated as the product of each patient’s use of resources and the corresponding unit costs. Baseline characteristics were similar between the groups. At 1 year, diabetic patients treated with stenting had the lowest event-free survival rate (63.4%) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG (84.4%, P P =0.04). Conversely, diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG (84.4% and 88.4%). The total 1-year costs for stenting and CABG in diabetic patients were $12 855 and $16 585 ( P Conclusions Multivessel diabetic patients treated with stenting had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting. The strategy of stenting was less costly than CABG, however, regardless of diabetic status.

PURPOSE: The authors analyzed the 30-day and 6-month outcomes of 1,126 consecutive patients who underwent coronary stent implantation in 1996 and 1997. METHODS: The 30-day results and 6-month angiographic follow-up were analyzed in patients treated with coronary stents in 1996 and 1997. All patients underwent coronary stenting with high-pressure implantation (>12 atm) and antiplatelet drug regimen (aspirin plus ticlopidine). RESULTS: During the study period, 1,390 coronary stents were implanted in 1,200 vessels of 1,126 patients; 477 patients were treated in the year 1996 and 649 in 1997. The number of percutaneous procedures performed using stents increased significantly in 1997 compared to 1996 (64 % vs 48%, p=0.0001). The 30-day results were similar in both years; the success and stent thrombosis rates were equal (97% and 0.8%, respectively). The occurrence of new Q wave MI (1.3% vs 1.1%, 1996 vs 1997, p=NS), emergency coronary bypass surgery (1% vs 0.6%, 1996 vs 1997, p=NS) and 30-day death rates (0.2% vs 0.5%, 1996 vs 1997, p=NS) were similar. The 6-month restenosis rate was 25% in 1996 and 27% in 1997 (p= NS); the target vessel revascularization rate was 15% in 1996 and 16% in 1997 (p = NS). CONCLUSIONS: Intracoronary stenting showed a high success rate and a low incidence of 30-day occurrence of new major coronary events in both periods, despite the greater angiographic complexity of the patients treated with in 1997. These adverse variables did not have a negative influence at the 6-month clinical and angiographic follow-up, with similar rates of restenosis and ischemia-driven target lesion revascularization rates.

The use of drug-eluting stents aiming at by-pass the disadvantage of stainless steel stents have been associated to late thrombosis after withdrawal of anti-platelet agents. We report a case with another complication, the development of a coronary aneurysm in the stent area more than three years after index procedure. Late chronic local inflammatory responses may be responsible for the weakening, erosion and aneusrysm formation.

Objetivo - Avaliar a eficiencia, a seguranca e a praticidade da angiografia coronaria com cateteres 4 French (F), pela tecnica de Judkins. Metodos - De agosto/95 a janeiro/96, 70 pacientes com suspeita de insuficiencia coronaria submeteram-se a cinecoronariografia , utilizando introdutores e cateteres 4F. Apos o exame, realizava-se compressao local por 15min e, 60min apos, os pacientes eram orientados a caminhar, sob vigilância , sendo dada a alta hospitalar apos 4h, . Resultados - A idade variou de 31 a 83 (m = 57) anos, sendo 39 (56%) homens, com peso entre 43 a 101 (m = 69) kg. Obteve-se otima qualidade de imagem em 62 casos (88%), havendo a necessidade de substituicao por cateteres de maior calibre (6 a 8F) em 8 (12%) pacientes. Nao ocorreram complicacoes vasculares ou sangramentos maiores. Em apenas 2 (3%) casos, houve discreto sangramento, resolvido com nova compressao local. Sessenta pacientes (85%) deambularam aos 60±5min e tiveram alta hospitalar com 4h, em media. Conclusao - A utilizacao de cateteres 4F por via femoral, para realizacao de cinecoronariografia permite a deambulacao muito precoce (media = 60±5min) e sem complicacoes hemorragicas. Verificaram-se pequena utilizacao de contraste (media = 60ml) e reducao da permanencia hospitalar. Esta tecnica torna o exame cinecoronariografico mais simples, menos traumatico e menos invasivo.

Background Previous studies have shown that coronary plaque composition plays a pivotal role in plaque instability, and imaging modalities and serum biomarkers have been investigated to identify vulnerable plaque. Virtual histology IVUS (VH-IVUS) characterizes plaque components as calcified, fibrotic, fibrofatty, or necrotic core. C-reactive protein (hsCRP) is an independent risk factor and a powerful predictor of future coronary events. However, a relationship between inflammatory response indicated by CRP and plaque characteristics in ACS patients remains not well established. Objective To determine, by using VH-IVUS, the relation between coronary plaque components and plasma high-sensitivity CRP levels in patients with acute coronary syndromes (ACS). Methods 52 patients with ACS were enrolled in this prospective study. Electrocardiographically-gated VH-IVUS were performed in the culprit lesion before PCI. Blood sample was drawn from all patients before the procedure and after 24 hours, and hs-CRP levels were determined. Results Mean age was 55.3±4.9 years, 76.9% were men and 30.9% had diabetes. Mean MLA was 3.9±1.3 mm², and plaque burden was 69±11.3%, as assessed by IVUS. VH-IVUS analysis at the minimum luminal site identified plaque components: fibrotic (59.6±15.8%), fibrofatty (7.6±8.2%), dense calcium (12.1±9.2%) and necrotic core (20.7±12.7%). Plasma hs-CRP (mean 16.02±18.07 mg/L) did not correlate with necrotic core (r=-0.089, p = 0.53) and other plaque components. Conclusions In this prospective study with patients with ACS, the predominant components of the culprit plaque were fibrotic and necrotic core. Serum hs C-reactive protein levels did not correlate with plaque composition.

Background: The newly developed balloon-expandable Mguard stent system, a combination of an ultra-thin polymer mesh sleeve attached to the external surface of a BMS, was conceived to provide embolic protection during PCI of SVG and thrombus-containig lesions. Although the acute results (

Aim Late-acquired incomplete stent apposition (ISA) has been documented after drug-eluting stent (DES) implantation; however, its clinical role remains controversial. We sought to investigate the incidence and long-term clinical consequences of late ISA after implantation of sirolimus- (SES) or paclitaxel-eluting stent (PES) in a non-selected population. Methods and results From our database, we analysed 195 consecutive patients who underwent DES placement (175 with SES and 20 with PES) into native artery lesions and had serial intravascular ultrasound studies (IVUS) performed at index procedure and after 6–8 months. They were clinically followed for 29 ± 15 months (median of 24.3 months, interquartile range 18.1–31.6 months). Late ISA was defined as separation of at least one stent strut from the vessel wall in a segment without a side-branch and where the immediate post-implantation IVUS revealed complete apposition of stent struts. We identified 10 patients (5.1%) with late ISA, three patients after PES, and seven patients after SES implantation. ISA was localized almost exclusively at body of the stents (nine out of 10 cases). Mean ISA volume and length were 44.5 ± 41.9 mm3 and 7.4 ± 11 mm, respectively. There was a marked increase in vessel volume from 416.0 ± 163.9 mm3 at baseline to 514.4 ± 247.9 mm3 at follow-up ( P = 0.001) with no significant change in plaque volume (232.4 ± 52.7 at baseline and 226.4 ± 22.3 mm3 at follow-up, P = 0.3) in patients who presented with late-acquired ISA. During the follow-up period, one patient with SES and one patient with PES who presented late-acquired ISA had late stent thrombosis and acute myocardial infarction. Conclusion Late-acquired ISA was observed in 5.1% of patients after DES implantation and is related to regional vessel positive remodelling. The relationship between late-acquired ISA and long-term adverse outcomes (e.g. stent thrombosis) requires further analysis.

OBJETIVO: Identificar os perfis clínico/angiográfico e relacionados ao procedimento de pacientes com angina instável atendidos em um hospital terciário e tratados por meio de intervenções coronarianas percutâneas. MÉTODOS: Estudo de uma casuística consecutiva de 1.413 pacientes, selecionados a partir de um banco de dados informatizado e revascularizados percutaneamente no triênio 2002-2004. Não houve critérios de inclusão/exclusão. RESULTADOS: Hipertensão arterial sistêmica (74%) e hipercolesterolemia (65%) foram os fatores de risco clássicos para doença coronariana mais observados. Antecedentes de infarto do miocárdio e cirurgia de revascularização miocárdica foram respectivamente observados em 28% e 24% dos casos. Os subgrupos mais comumente tratados foram o IIB (48%) e IIIB (28%). O clopidogrel foi prescrito a 51% dos pacientes, enquanto os inibidores IIb IIIa foram utilizados em 7%. Doença coronariana multiarterial na cinecoronariografia diagnóstica ocorreu em 42% dos casos. Lesões-alvo tipo B2 ou C foram tratadas em 64%, das quais 94% situavam-se em vasos naturais. Lesões reestenóticas foram dilatadas em 5% dos pacientes. Todas as intervenções foram realizadas utilizando os stents coronarianos, a maioria dos quais (67%) do tipo convencional. CONCLUSÕES: 1) os subgrupos IIB e IIIB foram os mais comumente tratados (76%); 2) o clopidogrel foi o antitrombótico mais prescrito (51%); 3) a coronariopatia multiarterial foi observada em 42% dos casos, com predomínio de lesões-alvo complexas e situadas em vasos naturais; 4) a técnica de dilatação predominante foi o implante dos stents coronarianos. OBJECTIVE: To identify clinical and angiographic profiles of patients with unstable angina seen at a tertiary hospital and treated with percutaneous coronary intervention (PCI). METHODS: Study of a consecutive series of 1413 patients, selected from a computerized database, who underwent percutaneous revascularization in the three-year period of 2002-2004. There were no inclusion/exclusion criteria. RESULTS: Systemic arterial hypertension (74%) and hypercholesterolemia (65%) were the classical risk factors for coronary disease most frequently observed. Coronary artery bypass grafting and history of myocardial infarction were found in 24% and 28% of the cases, respectively. The subgroups most commonly treated were the IIB (48%) and IIIB (28%). Clopidogrel was prescribed for 51% of the patients and glycoprotein IIb/IIIa inhibitors, for 7%. Multivessel disease evidenced by coronary angiography was detected in 42% of the cases. Type B2 or C lesions were treated in 64%, 94% of which in native vessels. Restenotic lesions were dilated in 5% of the patients. All interventions were performed using coronary stents, the majority of which (67%) were standard bare-metal stents. CONCLUSIONS: 1) Subgroups IIB and IIIB were the most frequently treated (76%); 2) Clopidogrel was the most prescribed antithrombotic agent (51%); 3) Multivessel coronary artery disease was found in 42% of the cases, most of which were complex target lesions located in native vessels; 4) Coronary stent implantation was the chief dilation technique used.

This pilot study evaluated the safety and efficacy of an intensified oral sirolimus regimen (15-mg loading dose 24 hr before PCI, followed by a daily dose of 5 mg for 4 weeks) in 15 patients subjected to elective bare metal coronary stent implantation for de novo lesions. Mean patient age was 59 ± 9; 73% were male, and 13% were diabetic patients. The reference diameter was 3.04 ± 0.38 mm, and the lesion length was 14 ± 2 mm. Angiographic and volumetric intravascular ultrasound (IVUS) analyses were performed in all patients at 6.0 ± 0.2 months. Two patients (13%) met the definition of in-segment binary restenosis; in-stent and in-segment angiographic late loss was 0.61 ± 0.31 mm and 0.67 ± 0.45 mm, respectively, and the percent neointimal volume was 28.5 ± 15.8%. At adjacent reference segments, there was neither significant plaque increase nor constrictive vascular remodeling. At 24-month follow-up no deaths, myocardial infarctions, or target lesion revascularizations were detected. Mean sirolimus blood level was 13 ± 7 ng/ml. No correlations were found between drug levels and late loss (r = 0.15, P = 0.59) or IVUS percent neointimal volume (r = 0.23, P = 0.47). Side effects were frequent (80%), leading to dose reductions in four and drug discontinuation in one patient. The results of this pilot study suggest that an intensified 5-mg oral sirolimus regimen resulted in no relevant improvements in the angiographic and IVUS parameters of restenosis after stent implantation in de novo lesions when compared with historic controls. Considering the efficacy/safety balance, our results do not encourage further trials evaluating the current protocol for the prevention of in-stent restenosis. © 2005 Wiley-Liss, Inc.

OBJETIVO: Verificar o efeito prognóstico das alterações de quatro marcadores de lesão miocárdica (CKMB atividade/massa e troponinas T e I) pós- stent em relação à ocorrência de morte, infarto e novos procedimentos de revascularização em um ano e determinar a incidência e as variáveis preditoras de suas elevações. MÉTODOS: Em 199 pacientes tratados por stents em artérias naturais foram mensurados os quatro marcadores em três períodos: pré-procedimento, 6-8h e 14-18h pós-stent. Curvas de sobrevivência e a regressão logística de Cox determinaram o impacto prognóstico das alterações na ocorrência de eventos cardíacos em um ano. RESULTADOS: A incidência das alterações dos 4 marcadores pós-stent é relativamente freqüente (6,1% a 32,8%), associa-se à maior complexidade das lesões tratadas (longas e angulações >45º) e ao desenvolvimento de intercorrências durante o procedimento (oclusão de ramos secundários, presença de angina e alterações eletrocardiográficas). A sobrevivência livre de infarto e nova revascularização foi significativamente menor somente nos pacientes com elevação da CKMB atividade pós-procedimento em comparação àqueles sem esta alteração (60% x 85,08%, p=0,025). Influenciaram a sobrevivência livre de eventos o diabetes mellitus (OR: 2,27, p=0,0256), pré-dilatação com balão (OR: 3,16, p=0,0082) e elevação da CKMB atividade pós-procedimento (OR: 3,64, p=0,0162). CONCLUSÃO: A recomendação da monitoração sistemática da CKMB atividade pós-stent coronário baseia-se na compreensão do seu comportamento clínico e laboratorial, nos resultados dos estudos que relacionam a elevação de seus níveis pós-procedimento à pior evolução tardia e ao baixo custo do exame. OBJECTIVE: To assess the prognostic effect of the changes in the levels of 4 biochemical markers of myocardial damage (CK-MB activity/mass and troponins T and I) after stent implantation in regard to the occurrence of death, infarction, and new myocardial revascularization procedures in a one-year period. The study also aimed at determining the incidence of their elevations and the existence of predictive variables. METHODS: Those 4 markers were measured in 199 patients treated with stent implantation in native arteries in the following 3 periods: before the procedure, 6-8 hours after the procedure, and 14-18 hours after the procedure. Survival curves and Cox logistic regression were used to determine the prognostic impact of the changes on the occurrence of cardiac events in one year. RESULTS: Changes in the levels of the 4 markers after stent implantation are relatively frequent (6.1% to 32.8%), are associated with the degree of complexity of the lesions treated (long lesions and angulations > 45º) and with the development of problems during the procedure (occlusion of the secondary branches, presence of angina, and electrocardiographic changes). The infarction-free survival rate and the need for a new revascularization were significantly lower only in the patients with an elevation in the CK-MB activity after the procedure as compared with those in patients without that alteration (60% x 85.08%; P=0.025). The following variables influenced the event-free survival rate: diabetes mellitus (OR: 2.27; P=0.0256), balloon predilation (OR: 3.16; P=0.0082), and an elevation in the CK-MB activity after the procedure (OR: 3.64; P=0.0162). CONCLUSION: Systematic monitoring of CK-MB activity after coronary stenting is justified due to its clinical and laboratory behavior reported in studies relating its elevation after the procedure to a worse late outcome, and due to its low cost.

OBJECTIVE: To assess the safety and efficacy of intracoronary brachytherapy using the Beta-Cath systemTM for preventing recurrence of in-stent restenosis (ISR), by analyzing clinical, angiographic, and intracoronary ultrasound (ICUS) results. METHODS: This study assessed 30 patients with ISR in native coronary arteries who underwent balloon catheter angioplasty followed by intracoronary beta radiation with the Beta-Cath systemTM (90Sr/Y). RESULTS: The study comprised complex, extensive (18.66±4.15 mm) restenotic lesions, 77% of which were of the diffuse-proliferative type. Brachytherapy was successful in 100% of the cases. The mean radiation dose used was 20.7±2.3 Gy, released for a mean period of 3.8±2.1 minutes. On late follow-up, the in-stent minimum luminal diameter (MLD) slightly decreased (from 1.98±0.30 mm to 1.84±0.39 mm at 6 months; P=0.13), with a late loss of 0.14±0.18 mm. The intrasegmentary MLD was significantly smaller than the in-stent diameter (1.55±0.40 mm vs 1.84±0.39 mm; P=0.008), and was associated with a more significant late loss (0.40±0.29 mm vs 0.14±0.18 mm; P=0.0001). On ICUS, a mild increase of 6.8±14.3 mm3 in the neointimal tissue was observed at 6 months (P=0.19), and the percentage of volumetric obstruction increased by 4.7±7.5%. Binary restenosis and revascularization of the target vessel recurred in 17% of the cases; late occlusion associated with myocardial infarction occurred in 1 case (3%). Event-free survival was 80%. CONCLUSION: The management of in-stent restenosis with intracoronary beta radiation proved to be a safe and effective procedure, with a high rate of immediate success, representing a therapeutic option for inhibiting neointimal hyperplasia.

Background— In diabetic patients in the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT) trial, abciximab reduced target vessel revascularization by ≈50% compared with placebo. Whether this is a result of a lower restenosis rate caused by inhibition of intimal hyperplasia remains to be defined. Methods and Results— The purpose of this study was to determine whether abciximab at the time of stent implantation would reduce in-stent intimal hyperplasia measured by intravascular ultrasound at 6-month follow-up in type 2 diabetics. Ninety-six diabetic patients (96 lesions) who underwent elective stent implantation for a de novo lesion in a native coronary artery were randomly assigned to receive abciximab or no abciximab. In-stent intimal hyperplasia volume, expressed as percentage of stent volume, did not differ between groups: 41.3±21.0% for those treated with abciximab versus 40.5±18.3% for those treated without abciximab ( P =0.9). There were also no significant differences in angiographic minimal luminal diameter at follow-up (1.74±0.69 versus 1.66±0.63 mm; P =0.5), late loss (1.03±0.63 versus 1.07±0.58 mm; P =0.7), restenosis rate (17.8% versus 22.9%; P =0.5), or cumulative incidence of major adverse cardiac events at 12 months (19.1% versus 20.4%; P =0.9). Conclusions— Six-month intravascular ultrasound volumetric analysis showed that abciximab, at the time of coronary stent implantation, was not associated with a reduction of in-stent intimal hyperplasia in diabetic patients.

Drug-eluting stents have been investigated as a treatment option for in-stent restenosis after bare metal stenting. However, it remains unclear whether overlapping drug-eluting stents have a toxic effect on the vessel wall. The aim of this study was to analyze the 1-year intravascular ultrasound findings after 2 overlapping sirolimus-eluting stent implantations in patients with in-stent restenosis lesions. Eight patients required 2 sirolimus-eluting stents, 18 mm in length, for full lesion coverage; these stents were implanted with >1-mm overlap. At 1-year follow-up, there were no significant quantitative changes in intravascular ultrasound measurements within the overlapped segment.

Background— We have previously reported the safety and effectiveness of sirolimus-eluting stents for the treatment of de novo coronary lesions. The present investigation explored the potential of this technology to treat in-stent restenosis. Methods and Results— Twenty-five patients with in-stent restenosis were successfully treated with the implantation of 1 or 2 sirolimus-eluting Bx VELOCITY stents in São Paulo, Brazil. Nine patients received 2 stents (1.4 stents per lesion). Angiographic and volumetric intravascular ultrasound (IVUS) images were obtained after the procedure and at 4 and 12 months. All vessels were patent at the time of 12-month angiography. Angiographic late loss averaged 0.07±0.2 mm in-stent and −0.05±0.3 mm in-lesion at 4 months, and 0.36±0.46 mm in-stent and 0.16±0.42 mm in-lesion after 12 months. No patient had in-stent or stent margin restenosis at 4 months, and only one patient developed in-stent restenosis at 1-year follow-up. Intimal hyperplasia by 3-dimensional IVUS was 0.92±1.9 mm 3 at 4 months and 2.55±4.9 mm 3 after 1 year. Percent volume obstruction was 0.81±1.7% and 1.76±3.4% at the 4- and 12-month follow-up, respectively. There was no evidence of stent malapposition either acutely or in the follow-up IVUS images, and there were no deaths, stent thromboses, or repeat revascularizations. Conclusion— This study demonstrates the safety and the potential utility of sirolimus-eluting Bx VELOCITY stents for the treatment of in-stent restenosis.

OBJECTIVE: Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI) in the first 24 hours of AMI. METHODS: The patients were divided into three different age groups (60/69, 70/79, and > or = 80 years) and were treated from 7/95 until 12/99. The primary success rate and the occurrence of major clinical events were analyzed at the end of the in-hospital phase. Coronary stent implantation and abciximab use were employed at the intervencionist discretion. RESULTS: We analyzed 201 patients with age ranging from 60 to 93 years, who underwent primary PCI. Patients with ages above 70 were more often female (p=.015). Those with ages above 80 were treated later with PCI (p=.054), and all of them presented with total occlusion of the infarct-related artery. Coronary stents were implanted in 30% of the patients. Procedural success was lower in > or = 80 year old patients (p=.022), and the death rate was higher in > or = 70 years olds (p=.019). Reinfarction and coronary bypass surgery were uncommon events. A trend occurred toward a higher combined incidence of major in-hospital events according to increased age (p=.064). CONCLUSION: Elderly patients ( > or = 70 years) presented with adverse clinical and angiographic profiles and patients > or = 80 years of age obtained reduced TIMI 3 flow success rates after primary PTCA, and those > or = 70 years had a higher death rate.

OBJECTIVE - This study compared the early and late results of the use of one single stent with those of the use of multiple stents in patients with lesions longer than 20mm. METHODS - Prospective assessment of patients electively treated with stents, with optimal stent deployment and followed-up for more than 3 months. From February '94 to January '98, 215 patients with lesions >20mm were treated. These patients were divided into 2 groups as follows: Group A - 105 patients (49%) with one stent implanted; Group B - 110 patients (51%) with multiple stents implanted. RESULTS - The mean length of the lesions was 26mm in group A (21-48mm) versus 29mm in group B (21-52mm) (p=0.01). Major complications occurred in one patient (0.9%) in group A (subacute thrombosis, myocardial infarctionand death) and in 2 patients (1.8%) in group B (one emergency surgery and one myocardial infarction) (p=NS). The results of the late follow-up period (>6 months) were similar for both groups (group A = 82% vs group B = 76%; p=NS), and we observed an event-free survical in 89% of the patients in group A and in 91% of the patients in group B (p=NS). Angina (group A = 11% vs group B = 7%) and lesion revascularization (group A = 5% vs group B = 6%; p=NS) also occurred in a similar percentage. No infarction or death was observed in the late follow-up period; restenosis was identified in 33% and 29% of the patients in groups A and B, respectively (p=NS). CONCLUSION - The results obtained using one stent and using multiple stents were similar; the greater cost-effectiveness of one stent implantation, however, seems to make this strategy the first choice.

Clinical and angiographic data were analysed in 244 pts submitted to a successful primary PTCA within 24 hrs of acute MI to determine predictors of early recovery in LV function. All pts had a LV angiogram before PTCA and at hospital discharge (HD – mean = 10 days). The end points were: analysis of arterial patency rate at HD and its relation to ejection fraction (EF) recovery and in pts with sustained arterial patency (SAP), which ones exhibit a greater increase in EF. P values l 0.05 were submitted to multivariate analysis (risk adjustment). Variable % Pre EF HD EF GAIN P Arterial Patency 91 43 ± 9 49 ± 8 + 6.1 ± 4% 0.001* Reocclusion 9 45 ± 8 41 ± 10 -3.4 ± 5% ONLY PTS WITH SAP: Anterior MI 52 41 ± 7 47 ± 9 + 6.3 ± 4% 0.02 Inferior MI 48 49 ± 9 52 ± 10 + 3.1 ± 2% Ischemia time l 4 hrs 42 44 ± 8 53 ± 9 + 9.4 ± 5% 0.001* Ischemia time g 4 hrs 58 44 ± 9 49 ± 5 + 5.1 ± 2% Multivessel disease 52 42 ± 9 50 ± 7 + 8.1 ± 4% 0.02 Single vessel disease 48 44 ± 10 48 ± 9 + 3.9 ± 3% Baseline EF l 40% 43 33 ± 9 42 ± 8 + 9.6 ± 5% 0.001* Baseline EF g 40% 57 51 ± 9 54 ± 5 + 3.2 ± 1% Conclusions Pts with SAP*and anterior Ml, multivessel disease, baseline EF l 40%*and early reperfusion*are likely to benefit most from primary PTCA in acute myocardial infarction (*independent variables).

ResumoIntroduçãoNo estudo BIOACTIVE, avaliamos as respostas vasculares após implante do stent eluidor de biolimus A9 (SEB; BioMatrix®) e o stent eluidor de everolimus (SEE; XIENCE V®). Apresentamos a análise de tomografia de coerência óptica (OCT) 6 meses pós‐intervenção.MétodosOs pacientes foram randomizados para tratamento com SEB (n = 22) ou SEE (n = 18). O desfecho primário foi a frequência de hastes não cobertas e mal apostas pela OCT.ResultadosA OCT foi realizada em 26 pacientes (SEB: n = 15; SEE: n = 11) e foram analisadas 749 imagens tomográficas e 7.725 hastes de stent. SEB e SEE apresentaram áreas luminais e dos stents semelhantes. A área de hiperplasia neointimal, a espessura neointimal e o porcentual de obstrução intra‐stent (8,44 ± 5,10% vs. 9,21 ± 6,36%; p = 0,74) foram similares. As taxas de hastes não cobertas (SEB: 2,10 ± 3,60% vs. SEE: 2,46 ± 2,15%; p = 0,77) e mal apostas (SEB: 0,48 ± 1,48% vs. SEE 0,44 ± 1,05%; p = 0,94) foram baixas e semelhantes. A frequência de frames com sinais compatíveis com infiltrado inflamatório peri‐haste foi baixa e similar entre SEB (15,53 ± 20,77%) e SEE (11,70 ± 27,51%; p = 0,68).ConclusõesStents farmacológicos de segunda geração SEB e SEE se mostraram igualmente eficientes em suprimir a formação neointimal aos 6 meses, com respostas vasculares favoráveis. A frequência de frames com sinais de infiltrado peri‐haste por paciente foi baixa, e menor do que a historicamente observada com os stents farmacológicos de primeira geração.AbstractBackgroundIn BIOACTIVE study, we evaluated vascular responses after the implant of biolimus A9‐eluting stent (BES; BioMatrixTM) and the everolimus‐eluting stent (EES; XIENCE VTM). In this study, we present the optical coherence tomography analysis (OCT) 6 months post‐intervention.MethodsPatients were randomized to treatment with BES (n = 22) or EES (n = 18). The primary outcome was the frequency of non‐covered, poorly positioned struts by OCT.ResultsOCT was performed in 26 patients (BES: n = 15; EES: n = 11) and 749 tomographic images and 7,725 stent struts were analyzed. BES and EES showed similar luminal and stent areas. Neointimal hyperplasia area, neointimal thickness and the percentage of in‐stent obstruction (8.44 ± 5.10% vs. 9.21 ± 6.36%; p = 0.74) were similar. The rates of not covered struts (BES: 2.10 ± 3.60% vs. ESS: 2.46 ± 2.15%, p = 0.77) and poorly positioned struts (BES: 0.48 ± 1.48% vs. EES 0.44 ± 1.05%, p = 0.94) were similarly low. The frequency of frames with signs consistent with peri‐strut inflammatory infiltrate was low and similar between BES (15.53 ± 20.77%) and EES (11.70 ± 27.51%; p = 0.68).ConclusionsThe second‐generation drug‐eluting stents BES and EES were equally effective at suppressing the neointimal formation after 6 months, with favorable vascular responses. The frequency of frames with peri‐strut infiltrate signals per patient was low, and lower than that observed historically with first‐generation drug‐eluting stents.

BACKGROUND The SYNTAX score was developed as an angiographic tool to grade the complexity of coronary artery disease in patients with three-vessel and/or left main disease. We evaluated its role in predicting clinical outcomes after percutaneous coronary intervention (PCI) in non-selected patients, treated in the daily clinical practice of a reference center. METHODS Analysis of patients undergoing PCI from March to September 2009 and followed-up for up to 12 months. Patients were divided in tertiles according to the SYNTAX score. The primary endpoint included major adverse cardiac events (MACE) – death, non-fatal acute myocardial infarction and target-vessel revascularization. The ability of the SYNTAX score in predicting MACE was assessed by the ROC (Receiver Operator Characteristic) curve. RESULTS Two hundred and thirty-four patients with a mean SYNTAX score of 11.6 ± 6.2 points were included. Tertile I had a SYNTAX score ≤ 9 (average 5.9); tertile II, > 9 and ≤ 13 (average 10.8); and tertile III, > 13 (average 18.3). In the clinical follow-up of 7.2 ± 4.9 months, the incidence of MACE was greater in tertile III when compared to tertiles I and II (2.5% vs. 6.4% vs. 14.1%; P = 0.0075). The ROC curve showed an area under the curve of 0.667 (P = 0.012) indicating a moderate ability to anticipate the occurrence of MACE in this population. CONCLUSIONS The SYNTAX score proved to be useful in predicting the occurrence of MACE after PCI in real world patients.

required a small increase in core temperature to 33.6*0.15”C. Meperidine and buspirone did not cause respiratory depression or other complications. Patients with shivering were younger (54 * 10 years vs. 59 * 12 years. p=O.O4), and received a higher total bolus dose of meperidine than those without shivering (156 f 66mg vs. 120 f 66mg, p=O.Ol). Mean patient weight and body surface area were similar in bath groups and no other demographic, clinical or hemodynamlc predictors of shivering were identified. Conclusion: Our results indicate that combination treatment with surface warming, buspirone and meperidine is safe and effective in patients with AMI, and provides a novel method for counteracting thermoregulatory defenses to systemic hypothermia during endovascular cooling. SES to control bare stents (CS), 462 pts (44%) had single vessel LAD treatment. In this cohort, reference vessel size was 2.74mm and lesion length was 14.0 mm. Results: Clinical (@ 9 months) and angiographic (@ 8 months) outcomes were compared in the SES and CS LAD subgroups (see table). Conclusions: The SIRIUS LAD substudy indicates striking improvement after SES in all clinical and angiographic efficacy parameters compared with CS. These SES results are equivalent to those reported after LIMA surgery, and thus, SES should be considered the new standard of care for stngle vessel LAD therapy.