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Objectives: The aim of this study was to compare 7-year outcomes between the first-generation sirolimus-eluting stent (SES) and the new-generation everolimus-eluting stent (EES) in a randomized clinical trial., Background: There is a scarcity of very long-term (beyond 5 years) data from clinical trials investigating whether new-generation drug-eluting stents have clear clinical advantages over first-generation drug-eluting stents., Methods: RESET (Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial) is the largest randomized trial comparing EES with SES (NCT01035450). Among a total of 3,197 patients in the original RESET population from 100 centers, the present extended 7-year follow-up study was conducted in 2,667 patients from 75 centers after excluding those patients enrolled from centers that denied participation. Complete 7-year follow-up was achieved in 91.5% of patients., Results: The cumulative 7-year incidence of the primary efficacy endpoint of target lesion revascularization was not significantly different between EES and SES (10.2% vs. 11.7%; hazard ratio: 0.87; 95% confidence interval: 0.68 to 1.10; p = 0.24). The risk for the primary safety endpoint of death or myocardial infarction trended lower with EES than with SES (20.6% vs. 23.6%; hazard ratio: 0.85; 95% confidence interval: 0.72 to 1.005; p = 0.06). The cumulative 7-year incidence of definite stent thrombosis was very low and similar between EES and SES (0.9% vs. 1.0%; p = 0.82). The lower risk of EES relative to SES was significant for the composite secondary endpoint of target lesion failure (13.3% vs. 18.1%; hazard ratio: 0.72; 95% confidence interval: 0.59 to 0.88; p = 0.001)., Conclusions: During 7 years of follow-up, the risk for target lesion revascularization was not significantly different between the new-generation EES and the first-generation SES., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The long-term safety and efficacy of drug-eluting stents for patients with acute myocardial infarction (AMI) remain controversial., Methods and Results: A total of 143 consecutive patients who presented between August 2004 and July 2006 with AMI and who underwent primary percutaneous coronary intervention (PCI) using sirolimus-eluting stents (SES), were compared with a historical control cohort of 129 consecutive patients who presented between August 2002 and July 2004 and who underwent primary PCI using bare metal stents (BMS). The rate of major adverse cardiovascular events at 3 years was significantly lower in the SES group than in the BMS group (20.3% vs. 33.1%, respectively; P=0.01). This reduction was mainly driven by a decrease in the rate of target vessel revascularization (12.3% vs. 22.4%, respectively; P=0.02). There was no significant difference in the rate of cardiovascular death (4.5% vs. 5.7%, respectively; P=0.67), non-fatal myocardial infarction (4.5% vs. 9.2%, respectively; P=0.16), coronary artery bypass grafting (2.3% vs. 2.5%, respectively; P=0.93), stroke (2.4% vs. 0.8%, respectively; P=0.35), and stent thrombosis (2.9% vs. 2.3%, respectively; P=0.80) between the 2 groups., Conclusions: SES can be used safely and effectively in patients with AMI.

Aim: Cardiopulmonary resuscitation (CPR) using extracorporeal life support (ECLS) for in-hospital cardiac arrest (IHCA) patients has been assigned a low-grade recommendation in current resuscitation guidelines. This study compared the outcomes of IHCA and out-of-hospital cardiac arrest (OHCA) patients treated with ECLS., Methods: A total of 77 patients were treated with ECLS. Baselines characteristics and outcomes were compared for 38 IHCA and 39 OCHA patients., Results: The time interval between collapse and starting ECLS was significantly shorter after IHCA than after OHCA (25 (21-43)min versus 59 (45-65)min, p<0.001). The weaning rate from ECLS (61% versus 36%, p=0.03) and 30-day survival (34% versus 13%, p=0.03) were higher for IHCA compared with OHCA patients. IHCA patients had a higher rate of favourable neurological outcome compared to OHCA patients, but the difference was not statistically significant (26% versus 10%, p=0.07). Kaplan-Meier analysis showed improved 30-day and 1-year survival for IHCA patients treated with ECLS compared to OHCA patients who had ECLS. However, multivariate stepwise Cox regression model analysis indicated no difference in 30-day (odds ratio 0.94 (95% confidence interval 0.68-1.27), p=0.67) and 1-year survival (0.99 (0.73-1.33), p=0.95)., Conclusion: CPR with ECLS led to more favourable patient outcomes after IHCA compared with OHCA in our patient group. The difference in outcomes for ECLS after IHCA and OHCA disappeared after adjusting for patient factors and the time delay in starting ECLS., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: Recent studies have demonstrated that stress-induced Tako-tsubo cardiomyopathy is likely to occur in elderly female patients., Objectives: The purpose of this study was to evaluate gender differences in the clinical characteristics of patients with Tako-tsubo cardiomyopathy., Methods: This study consisted of 102 patients with Tako-tsubo cardiomyopathy. It was characterized by akinesia/hypokinesia of the mid-to-distal portion of the left ventricular chamber, with normokinesia/hyperkinesia of the basal portion with an ejection fraction of less than 50% on transthoracic echocardiography., Results: There were 13 male and 89 female patients. In 10 male patients (77%), Tako-tsubo cardiomyopathy occurred during or immediately after receiving medical treatment or examination for an underlying disease. In 9 male patients (69%), objective symptoms such as abnormality of monitoring or low blood pressure, but not subjective symptoms increased the chance of the patient being diagnosed with Tako-tsubo cardiomyopathy. There was no significant difference in age, body weight, hypertension, or diabetes except for height between male and female patients. The incidence of in-hospital onset was significantly higher in male patients than in female patients (77% vs 17%, P < 0.01). There was no significant difference in in-hospital mortality (15% vs 6%, P = not significant)., Conclusions: These results suggested that physical stress might have more to do with the occurrence of Tako-tsubo in male than female patients., (Copyright 2010 Wiley Periodicals, Inc.)

Aim: To investigate the impact of a history of diabetes mellitus on the neurologic outcome in comatose survivors of cardiac arrest of cardiac origin treated with mild hypothermia., Methods: A prospective observational study was performed between September 2003 and July 2008. Eighty comatose survivors of cardiac arrest of cardiac origin were treated with mild hypothermia. Neurologic outcome at the time of hospital discharge, 30-day survival, and complications were assessed., Results: Twenty-four of the 80 patients (30%) had a history of diabetes. The rate of favorable neurologic outcome was significantly lower in diabetic (17%) than in nondiabetic patients (46%) (p=0.01). The rate of 30-day survival was lower in diabetic (33%) than in nondiabetic patients (54%), but the difference was not significant (p=0.10). Multivariate analysis suggested that a history of diabetes was an independent predictor of unfavorable neurologic outcome (odds ratio 7.00, 95% confidence interval 1.42-46.19, p=0.03), but not for 30-day survival. There was no significant difference in the prevalence of complications., Conclusion: A history of diabetes is associated with poor neurologic outcome in comatose survivors of cardiac arrest treated with mild hypothermia.

Purpose: The purpose of this study was to assess the usefulness of electrocardiogram on admission to predict short-term prognosis in patients with acute myocardial infarction (AMI) associated with left main coronary artery (LMCA)., Methods: Electrocardiogram was obtained on admission in 41 patients with AMI associated with LMCA who underwent reperfusion therapy. Electrocardiographic findings were compared between nonsurvivors and survivors., Results: There were 24 nonsurvivors and 17 survivors during 30-day follow-up. Nonsurvivors had ST-segment elevation in both leads aVR and aVL (54% vs 18%, P < .05), left anterior fascicular block (83% vs 41%, P < .05), and right bundle-branch block (54% vs 18%, P < .05) more frequently, and ST-segment depression in lead V(5) (17% vs 59%, P < .05) less frequently than survivors among patients with AMI associated with LMCA., Conclusions: Our data suggested that electrocardiogram on admission might be useful to predict short-term prognosis in patients with AMI associated with LMCA.