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Background: Procedural results for percutaneous coronary intervention (PCI) in coronary vessels with chronic total occlusion (CTO) have improved in recent years, and PCI strategies have moved toward more complete revascularization with more liberal use of CTO-PCI. However, evidence evaluating CTO-PCI is limited to observational studies and small clinical trials. Methods: In this open-label, multicenter, randomized, noninferiority trial, PCI-eligible patients were assigned to receive either 1 of 2 strategies: PCI or no PCI for the qualifying de novo CTO lesion with the option for PCI of obstructive non-CTO lesions at the discretion of the operator. The primary end point was a composite of death, myocardial infarction, stroke, or any revascularization. Health-related quality of life was assessed at baseline and at 1, 6, 12, 24, and 36 months. Because of slow recruitment, the trial was stopped before completion of the 1284 planned enrollments. Results: Between March 2010 and September 2016, 834 patients were randomly assigned to the CTO-PCI (n=417) or no CTO-PCI (n=398) strategy. Among the patients assigned to the no CTO-PCI strategy, 78 (19.6%) crossed over to receive staged CTO-PCI within 3 days of randomization. The overall CTO-PCI success rate was 90.6%. Serious nonfatal complications associated with CTO-PCI occurred in 3 patients (1 stroke, 1 cardiac tamponade, and 1 patient with recurrent episodes of ventricular tachyarrhythmia induced by intracoronary thrombus). Approximately half of the patients in each group underwent PCI for an average of 1.3 non-CTO lesions, resulting in a comparable residual SYNTAX score (Synergy Between PCI With TAXUS and Cardiac Surgery; 3.7±5.4 versus 4.0±5.9, P =0.42) confined to non-CTO vessels. During a median follow-up of 4.0 years (interquartile range, 2.4 to 5.1 years), there was no significant difference between the CTO-PCI and the no CTO-PCI strategies in the incidence of the primary end point (22.3% versus 22.4%, hazard ratio, 1.03; 95% CI, 0.77 to 1.37; P =0.86). Both CTO-PCI and no CTO-PCI strategy were associated with significant improvements but without between-group differences in disease-specific health status that was sustained through 36 months. Conclusions: CTO-PCI was feasible with high success rates. There was no difference in the incidence of major adverse cardiovascular events with CTO-PCI versus no CTO-PCI, but the study was limited by low power for clinical end points and high crossover rates between groups. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01078051.

Procedural results for percutaneous coronary intervention (PCI) in coronary vessels with chronic total occlusion (CTO) have improved in recent years, and PCI strategies have moved toward more complete revascularization with more liberal use of CTO-PCI. However, evidence evaluating CTO-PCI is limited to observational studies and small clinical trials.In this open-label, multicenter, randomized, noninferiority trial, PCI-eligible patients were assigned to receive either 1 of 2 strategies: PCI or no PCI for the qualifying de novo CTO lesion with the option for PCI of obstructive non-CTO lesions at the discretion of the operator. The primary end point was a composite of death, myocardial infarction, stroke, or any revascularization. Health-related quality of life was assessed at baseline and at 1, 6, 12, 24, and 36 months. Because of slow recruitment, the trial was stopped before completion of the 1284 planned enrollments.Between March 2010 and September 2016, 834 patients were randomly assigned to the CTO-PCI (n=417) or no CTO-PCI (n=398) strategy. Among the patients assigned to the no CTO-PCI strategy, 78 (19.6%) crossed over to receive staged CTO-PCI within 3 days of randomization. The overall CTO-PCI success rate was 90.6%. Serious nonfatal complications associated with CTO-PCI occurred in 3 patients (1 stroke, 1 cardiac tamponade, and 1 patient with recurrent episodes of ventricular tachyarrhythmia induced by intracoronary thrombus). Approximately half of the patients in each group underwent PCI for an average of 1.3 non-CTO lesions, resulting in a comparable residual SYNTAX score (Synergy Between PCI With TAXUS and Cardiac Surgery; 3.7±5.4 versus 4.0±5.9, P=0.42) confined to non-CTO vessels. During a median follow-up of 4.0 years (interquartile range, 2.4 to 5.1 years), there was no significant difference between the CTO-PCI and the no CTO-PCI strategies in the incidence of the primary end point (22.3% versus 22.4%, hazard ratio, 1.03; 95% CI, 0.77 to 1.37; P=0.86). Both CTO-PCI and no CTO-PCI strategy were associated with significant improvements but without between-group differences in disease-specific health status that was sustained through 36 months.CTO-PCI was feasible with high success rates. There was no difference in the incidence of major adverse cardiovascular events with CTO-PCI versus no CTO-PCI, but the study was limited by low power for clinical end points and high crossover rates between groups.URL: https://www.clinicaltrials.gov . Unique identifier: NCT01078051.

In patients with ST-elevation myocardial infraction (STEMI), the risk stratification identified patients who were more concerning and may benefit from more aggressive management. In this study, the accuracy to predict short-and long-term mortality of the Thrombolysis in Myocardial Infarction (TIMI)

Radiation induced skin injuries in interventional procedures started to be reported in early 1990s and are still appearing [1–9]. A number of reasons have been cited e.g. complexity of procedure and equipment, lack of awareness on the part of interventionist, complexity of procedure, prolonged or multiple procedures, lack of monitoring of radiation dose, unnecessary body part in the beam and thick body mass in the beam. In rare situations patients with elevated radiosensitivity are encountered resulting in radiation injury. Restoration of patency of a chronic total occlusion (CTO) is typically associated with prolonged fluoroscopy exposure and there is higher potential for radiation injury. Three cases of CTO involving multiple PCIs and resulting in skin injuries occurring in 2009 alone are reported here. This is the first report of radiation induced skin injuries in Thailand from fluoroscopically guided PCI. Tables 1 and 2 provide overall and detailed information about each case in terms of radiation exposure and relevant details. Case 1, 67-y-old man, underwent 3 PCIs for CTO. Skin lesion of National Cancer Institute (NCI) grade toxicity of 1 [9] was detected by nurse 6 weeks after 3rd PCI when the patient was being prepared for the PCI after failed CTO in last visit. He didn't know exactly when it happened but realized about 3 weeks after PCI. It started with erythematous patch in the back close to right shoulder (Fig. 1). It healed without ulcer, however, hyperpigmentation has persisted for the least 7 months. Because his symptom of chest pain was of mild

To evaluate the results of long Micro Stent II (MS-XL) implantations, 119 MS-XLs were implanted in 102 patients (age, 62.83 years). Nineteen stents (16%) were implanted in saphenous vein grafts; 100 stents (84%) were implanted in native coronary arteries. Twenty-five patients (25%) were treated because of acute myocardial infarction (AMI); 30 patients (29%) because of unstable angina or angina class IV, and 47 patients (46%) because of stable angina. Eighty-six de novo lesions (84%) and 16 restenotic lesions (16%) were treated. Indications for stent implantation include elective, 61 patients (60%); suboptimal balloon angioplasty result, 22 patients (21%); and bailout after balloon angioplasty, 19 patients (19%). Because of residual thrombus after stenting, 27 patients (26%) received abciximab. All patients received ticlopidin for 28 days and acetylsalicylic acid. One hundred and seventeen MS-XLs (98%) were implanted successfully. Additional (shorter) MS-II were implanted in 40 patients (39%). The stented segment length was 45 ± 20 mm. The minimum lumen diameter increased from 0.5 ± 0.5 mm before to 2.7 ± 0.5 mm after stent implantation. The acute gain was 2.2 ± 0.4 mm. Early clinical events (

The 4-week outcome following Micro stent implantation for acute myocardial infarction was assessed with the use of two different antithrombotic regimens. The patients were postprocedurally treated with acetyl salicylic acid (ASA) and heparin for 24-48 h (Group I; n = 52), or ASA and ticlopidine plus abciximab if indicated (Group II; n = 52). Stent implantation was successful in 49 patients (94%) of group I and in 46 patients (89%) of group II (NS). Subacute stent thrombosis occurred in nine patients (17%) of group I and in 1 patient (2%) of group II (P < 0.05). There were no significant differences in the rates of mortality, coronary bypass operation, or vascular complications. Micro stent implantation in acute myocardial infarction is highly effective and associated with a low risk for subacute stent thrombosis if the patients are postprocedurally treated with ASA and ticlopidine plus abciximab if indicated.

The aim of this study is to compare the safety and efficacy of Sirolimus (SES), Paclitaxel (PES), Zotarolimus (ZES–R/Endeavor Resolute), BiolimusA9 (BES), EPC capture (ECS) and Everolimus–eluting stent (EES) on the outcome of patients with chronic total occlusion (CTO). A prospective analysis

To compare the efficacy and safety of original (Plavix) and generic (Apolets) clopidogrel 600 mg loading in patients planning to undergo coronary angiography.This is an experimental design, parallel, randomized-controlled study. Coronary artery disease patients planned for cardiac catheterization were recruited Patients were randomized to receive either original or generic clopidogrel 600 mg loading dose. Platelet aggregation induced by 5 micromol/L and 20 micromol/L adenosine diphosphate (ADP) was measured by light transmission aggregometry (LTA) at baseline and 6 hours after clopidogrel 600 mg administration.Forty-nine patients were enrolled, 24 patients received original clopidogrel, and 25 patients received generic clopidogrel. After six hours of loading, there was significantly reduction in platelet aggregation induced by adenosine 5 micromol/L from 41.08 +/- 3.04% to 19.50 +/- 1.68% (p0.001) in original group compared to 36.76 +/- 2.66% to 21.32 +/- 2.60% (p0.001) in generic group. When induced by 20 micromol/L, the platelet aggregation was reduced from 58.50 +/- 2.09% to 32.25 +/- 2.30% (p0.001) in original group and from 61.12 +/- 2.54% to 30.04 +/- 3.14% (p0.001) in generic group. There was no significant difference between original and generic clopidogrel in reducing platelet aggregation induced by both adenosine 5 and 20 micromol/L. Groin hematoma was found in one case (4.2%) in the original clopidogrel group.Generic clopidogrel (Apolets) 600 mg loading dose is as effective as original clopidogrel (Plavix) in term of platelet aggregation inhibition.

Aim: The aim of study is to compare the 5 years clinical outcome of drug-eluting stent implantation in high-angled (≥70°) bifurcation (HAB) and lower-angled (≤70°) bifurcation (LAB) lesion of unprotected left main coronary arteries. Methods: A prospective analysis of 488 patients with LMT stenosis (374 HAB and 114 LAB) in five high volume Asian centers after successful stenting in LMT was performed. LMT was treated with 5 strategies (single 195, mini-crush 116, culotte 89, T 47 cases, crush 32 cases, kissing 9). Results: At 5 years overall cardiac events of LAB (20.2%) were significantly lower than HAB (29.1%) (p=0.014). Conclusion: Drug-eluting stent implantation in low-angled LMT bifurcation lesion showed lesser incidence of cardiac events (death, myocardial infarction, CABG and PCI) compared with high-angled LMT bifurcation lesion of unprotected left main coronary arteries at 5 years clinical follow-up.

Primary percutaneous coronary intervention (PCI) appears to be the preferred reperf usion methodfor patients with ST-segment elevation myocardial infarction (STEMI). This method was introduced in our hospital before the year 2000. In Thailand, data showing long experience results in patients with STEMI who underwent primary percutaneous coronary intervention remain limited.To demonstrate 11-yr experience of primary percutaneous coronary intervention at King Chulalongkorn Memorial Hospital.This retrospective descriptive single-center study analyses clinical characteristics, angiographic features and in-hospital outcomes of 772 patients with STEMI who underwent primary percutaneous coronary intervention between 2000 and 2010.Seven hundred seventy two consecutive patients with STEMI were enrolled in the study. Three-fourth of the patients were male. Mean age was 60.13 years (range 28 to 96 years) and 12.6% were older than 75 years old. Forty-eight percent of patients were referred from hospital without cardiac catheterization facilities. Of these patients 94.4% underwent primary PCI and rescue PCI was done in 5.6% of patients. There were 27% ofpatients with left ventricular ejection fraction less than 40%, 21% of patients with Killip's class IV and 12% suffered cardiac arrest prior to angiography. Median door-to-balloon time in referred and non-referred patients was 28 and 104.5 minutes, respectively. Ninety-two percent of referred patients and 36% of non-referred patients, door to balloon time were within 90 minutes. About half ofthe patients had multi-vessels disease at that time of diagnosis. The overall angiographic success rate was 96%. Platelet glycoprotein llb/lla inhibitors were used in two-third ofpatients and stent placement in 82%. Post procedural thrombolysis in myocardial infarction (TII) 3 flow was documented in 87%. Intra-aortic balloon pump was used in 15% and thrombus aspiration device in 47%. During hospital stay, in-hospital mortality was 8.5% and 80% of those cases died from cardiac cause. One-third of patients died if they had Killip's class IV at presentation compared with 1.6% in patients with Killip's class I-III. In-hospital major adverse cardiovascular event was 10.4%.During 11 years of primary PCI experience in King Chulalongkorn Memorial Hospital, the angiographic success rate was high with acceptable in-hospital mortality and major adverse cardiac event. This strategy of treatment should be the treatment of choice for patients with STEMI in experienced PCI capable center with 24 hours/7 days availability.

Aim: The aim of this study is to compare the safety and efficacy of Sirolimus (SES), Paclitaxel (PES), Zotarolimus (ZES-R/ Endeavor Resolute), BiolimusA9 (BES), EPC capture (ECS) and Everolimus-eluting stent (EES) on the outcome of stenting in patients with diabetic very long coronary lesion (VLL) (lesion length ≥40 mm). Methods: A prospective analysis of 1317 patients with diabetic VLL (328 SES, 280 PES, 189 ZES-R, 190 BES, 143 ECS, 187 EES) was performed. The study endpoints were major adverse cardiac events (MACE) at 12 months, restenosis rate and target lesion revascularization (TLR) at 12 months. Results: See table for clinical results. Conclusion: (1) The use of drug-eluting stents in patients with diabetic VLL seems to be favorable in terms of in-hospital clinical outcome and long-term results. (2) Patients treated with BES and EES showed lesser restenosis rate and TLR compared with PES and ECS.

Left Main Coronary Artery (LMCA) disease is now uniformly treated with coronary artery by pass grafting (CABG). However some patients with LMCA disease did not receive CABG because of high operative risks as well as those who refused CABG Recent studies demonstrated the feasibility of stenting for LM stenosis, although data remain limited.To evaluate in-hospital and mid-term outcomes of using bare metal stent (BMS) and drug eluting stent (DES) in protected and unprotected left main coronary artery disease at King Chulalongkorn Memorial Hospital.Retrospective, single-center study. The authors reviewed the outcomes of patients who underwent percutaneous coronary intervention on left main coronary artery lesions in our hospital from July 2000 to August 2007. In-hospital data and clinical follow-up outcomes were analyzed and determined as in-hospital and mid-term mortality, major adverse cardiac event (MACE).In eight years the authors reviewed 64 consecutive protected and unprotected LMCA patients who underwent PCI with stent placement. Altogether left main coronary artery stents were successfully deployed in all patients. DES usage was 64%. Bifurcation technique for distal left main coronary artery was executed in 32 patients (50%), included single stent in 62 (97%), two stents in 2(3%). Final kissing ballon inflation was done in 14 (21.9%). In-hospital mortality was 4.7% (three patients), two patients died from cardiac origin. The total in-hospital major adverse cardiac event (MACE) was 4.7%. Clinical follow-up of 6 months was completed in 100% of patients. Fifty percent of patients had angiographic follow-up and in-stent restenosis rate was 9.7%. No further death was noted and MACE at 6 months was 9.4%. Moreover, overall mean and median follow-up period were 31 +/- 25 months (range, 6-93 months) and 26 months respectively.Stent Implantation was technically feasible and safely applied for the treatment ofprotected and unprotected left main coronary artery lesions in patients, with acceptable in-hospital and mid-term outcomes. More randomized and controlled clinical trials are needed to confirm the long-term effects of stents for LMCA disease.

The aim of this study is to compare the safety and efficacy of Sirolimus (SES), Paclitaxel (PES), Zotarolimus (ZES), EPC capture (ECS) and Everolimus-eluting stent (EES) on the outcome of patients with chronic total occlusion (CTO). A prospective analysis of 1149 patients with 1183 CTOs (396 SES, 526 PES, 177 ZES, 41 ECS, 43 EES) in five high volume Asian centers after successful recanalization of CTO was performed. The study endpoints were 30 days and 9 months major adverse cardiac events (MACE), 9 months angiographic restenosis and target lesion revascularization (TLR). See table for clinical results. The use of drug-eluting stents in patients with CTO was safe with low acute complication. Patients treated with SES and EES showed lesser rate of restenosis compared with other drug-eluting stents.

Aim : The aim of this study is to compare the 4 years safety and durability of drug-eluting stent implantation in non-bifurcation (ostium and/or mid shaft) (N-Bifur) and bifurcation (Bifur) lesion of unprotected left main coronary arteries (LMT). Methods : A prospective analysis of 448 patients with LMT stenosis (324 Bifur and 124 N-Bifur) in five high volume Asian centers after successful stenting in LMT was performed. LMT was treated with 5 strategies (single stenting 195 cases, T-stenting 47 cases, crush stenting 38 cases, Mini-crush stenting 93 cases, culotte stenting 54 cases, kissing stenting 21 cases). Complete clinical follow-up to 4 years is being analyzed for all 448 patients. Results : The baseline clinical characteristics between 2 groups were similar. Angiographic and clinical success were achieved in all patients without any major complication. At 4 years overall cardiac events of N-Bifur (14.5%) were significantly lower than Bifur (28.0%) (p=0.011). See figure for clinical results. Conclusion : The use of drug-eluting stent in patients with LMT was safe and feasible with low acute complication and low incidence of restenosis. Drug-eluting stent implantation in non-bifurcation lesion of LMT showed lesser incidence of cardiac events (death, myocardial infarction, CABG and PCI) compared with those of bifurcation lesion at 4 years clinical follow-up.

Aim : The aim of this study is to compare the 4 years safety and durability of Sirolimus-eluting stent (SES) and Paclitaxel-eluting stent (PES) deployment on the outcome of patients with very long coronary lesions (VLL). Methods : A prospective analysis of 656 patients 730 lesions (male 70.4%, mean age 66.9 yrs) with very long coronary lesion (≥40mm) (368 SES and 288 PES) in five high volume Asian centers after successful stenting in VLL was performed. Lesion locations of VLL were LAD 48.2% (SES 50.2%, PES 45.7%), LCX 18.5%, RCA 33.3%. Complete clinical follow-up to 4 years is being analyzed for all patients. Results : The baseline clinical characteristics between 2 groups were similar. At 4 years overall cardiac events of SES (16.3%) were lower than PES (24.0%) (p=0.03). See table for clinical results. Conclusion : The use of SES and PES in patients with very long coronary lesion was safe and feasible with low acute complication and low incidence of restenosis. SES showed lesser incidence of cardiac events (death, myocardial infarction, CABG and PCI) at 4 years clinical follow-up. SAT (sub acute stent thrombosis), LAST (late stent thrombosis: ~1year), VLAST (very late stent thrombosis: 1year~ 4years) MACE (death, myocardial infarction, CABG and PCI).

Early primary coronary interventions (PCI) in acute ST elevation myocardial infarction (STEMI) is associated with improved outcome and mortality rate but delayed reperfusion especially after 6 hours is still doubtful in terms of clinical benefits because most myocardial muscle are infarcted after 6 hours of onset of chest pain.The aim of the present study was to compare the mortality rate of patients treated with PCI within 6 hours of symptom onset to those treated between 6 to 24 hours after the onset of STEMI.The present study included consecutive patients from the data of the Fast Track Registry of King Chulalongkorn Hospital from June 1, 1999 to October 31, 2003 to compare the thirty-day mortality of patients treated with early or delayed PCI (0-6 hours vs. 6-24 hours after symptom of chest pain) for STEMI.Two hundred and sixteen patients who underwent PCI were enrolled. Male gender (82% vs. 64.9%, p = 0.03) and history of smoking (72.1% vs. 50%, p = 0.04) were predominant in the early treatment group (ETG) vs. the delayed treatment group (DTG). Mean age (60.5% vs. 61.03%, p = 0.11), diabetes (31.4% vs. 29.7%, p = 0.82), hypertension (64.0% vs. 54.1%, p = 0.20), dyslipidemia (58.1% vs. 60.8%, p = 0.73), and ejection fraction40% (22.8% vs. 32.0%, p = 0.625) were similar in both groups. There were no differences in angiographic finding and hospital management. Door to balloon and total delay time were 124.13 +/- 143.27 min and 407.94 +/- 268.183 min, respectively. The thirty-day mortality (9.01% vs. 12.76%, p = 0.379) and I year mortality (12.4% vs. 16 9%, p = 0.532) were not significantly determined by Log rank test in both groups. As for cardiogenic shock, ETG tended to have a lower thirty-day mortality than DTG but no statistically significant difference (12.5% vs. 50.0%, p = 0.0809).The delayed PCI up to 24 hours in STEMI does not increase short-term mortality at thirty days; therefore, it may still have benefit in STEMI patients. However it tended to have higher short-term mortality than early PCI especially in cardiogenic shock but showed no statistical significance.

Percutaneous coronary intervention (PCI) is now a favorable treatment for acute ST elevation myocardial infarction (STEMI). However, in non-official hours (non-OH), this modality of treatment has a questionable outcome because of the treatment delay.To compare the outcomes of PCI during official hours (OH) with non-OH in acute STEMI patients.A prospective consecutive registry of PCI in acute ST-elevation MI patients at King Chulalongkorn Memorial Hospital from May 1999 to December 2003 were analyzed. Kaplan Meier survival analysis was used to determine the in-hospital mortality. Multivariate analysis was used to determine the prognostic factors for in-hospital mortality.Two hundred and fifty six consecutive patients (OH-107, non-OH-149) who underwent PCI for acute STEMI were enrolled. Their mean age (61.9 +/- 12.2 vs 60.6 +/- 12.8 y, p = ns), male gender (73.8% vs 73.2%, p = ns), history of diabetes (30.2% vs 33.8%, p = ns), severity of the patients (percent of patients in Killip IV--22.4 vs 21.5, p = ns), ejection fraction (48.7 +/- 15.1 vs 45.9 +/- 14.7, p = ns), cardiopulmonary resuscitation prior PCI (15.0% vs 14.2%, p = ns), anterior MI (55.1% vs 51.0%, p = ns) were similar in both groups. Hypertension was slightly less common (39.6% vs 52.7%, p = 0.04) but smoking was more common (62.6% vs 49.0%, p = 0.03) in OH group. Door to balloon time and decision to balloon time were significantly shorter in the OH group than the non-OH group (67.9 +/- 47 vs 119.6 +/- 83 min, p0.001 and 60.8 +/- 35 vs 98.3 min, p0.001). However, the total delayed time was not statistically significantly different (402 +/- 316 vs 424 +/- 215, p = 0.55). Angiographic success rate was achieved in 98.1% for the OH group and 94.7% in the non-OH group (p = ns). In-hospital mortality rate was 10.3% and 10.7% respectively.The door to balloon time for PCI in acute STEMI patients in the non-OH group was longer than the OH group; however, the total delayed time was not different. The in-hospital mortality rate was similar.

Many reports have shown that female gender carries a worse prognosis when developing acute myocardial infarction (MI), whether or not reperfusion therapy is used. The primary percutaneous coronary intervention (1-PCI) is currently a preferable treatment for acute ST-elevation MI. However, the data concerning the difference between the outcomes in the treatment of the disease in men and women in Thailand is still insufficient.A prospective registry of acute ST-elevation MI patients who underwent 1-PCI at King Chulalongkorn Memorial Hospital from June 1999 to December 2002 were analyzed. Kaplan Meier survival analysis is used to determine the in-hospital mortality.The consecutive 184 (F-52, M-131) patients who underwent 1-PCI were recruited. Female subjects were older (66.6 +/- 12 y versus 59.0 +/- 11.6 y, p0.01); they also had higher percentage of diabetes (45.1 versus 27.1, p0.01), but a fewer number of smoker (17.7 versus 66.2, p0.001). The percentage of patients who had cardiogenic shock tended to be higher in women (34.6 versus 19.9, p = 0.08); however, the number of anterior wall MI and ejection fraction were not different. The mean door to balloon time (109 +/- 95 versus 99 +/- 68 minutes) and pain to balloon time (454 +/- 271 versus 372 +/- 298 minutes) were not different in both groups. The angiographic success with TIMI 3 flow was achieved in 92.3% for females and 86.9% for the males. The in-hospital mortality was significantly higher in females (23.1 versus 6.1, p = 0.002). Univariate analyses demonstrated that the feminine gender, cardiogenic shock, smoking, ejection fraction less than 40, cardiac arrest prior PCI and angiographic were the predictors for in-hospital mortality. When using multivariate analyses by Cox proportional model, only cardiogenic shock, history of hypertension and angiographic success were the significant predictors. Women had 2.15 times of in-hospital mortality higher than males; however, the confidence interval cross-over 1 (0.74-6.42) and p value was 0.16.Females tend to have a poor prognosis when they develop acute ST-elevation MI which requires treatment with 1-PCI.

Several randomized trials have demonstrated that stent implantation after successful recanalization of long-term total occlusions decreases restenosis and reocclusion rates. The sirolimus-eluting stent (SES) has recently proved its efficacy to decrease restenosis in selected patients. However, the efficacy of SES implantation in patients who have chronic total occlusions is currently unknown. Therefore, we investigated procedural and 6- and 12-month angiographic outcomes (analyzed by quantitative coronary angiography) and left ventricular function in 60 patients who received SESs and 120 patients who received bare metal stents (BMSs). Minimum luminal diameter did not differ immediately after recanalization (SES group 3.04 +/- 0.50 mm vs BMS group 3.12 +/- 0.48 mm). After 6 months, the SES group still had significantly larger luminal diameters (3.04 +/- 0.44 mm vs 1.94 +/- 0.98 mm) and significantly lower restenosis and reocclusion rates (2% and 0%, respectively) than did the BMS group (32% and 6%, respectively). Late loss was significantly smaller in the SES group than in the BMS group. At follow-up, the SES group had fewer cardiac events, including target lesion revascularization (p0.001), than did the BMS group. In conclusion, SES implantation after recanalization of chronic total occlusion provides a better clinical outcome with less restenosis and target lesion revascularization after 6 months than does BMSs.

PTCA is one of the treatments for coronary heart disease. But in Thailand, there is no available data on the long-term outcomes of patients who have undergone this procedure. To determine initial and long-term outcomes of patients who underwent percutaneous transluminal coronary angioplasty (PTCA), patients who underwent PTCA from January 1996 to December 1997 were enrolled. The initial results were received from the PTCA registry. The follow-up data were collected from medical records, phone calls and mail. Three hundred and forty patients (male 68.8%) were enrolled. Mean age was 61.8 +/- 10.1 years. Dyslipidemia was the most common risk factor (50.3%), followed by hypertension (44.4%), smoking (40%), and diabetes (33.8%). Indications for PTCA were chronic stable angina (47.9%), unstable angina (22.1%), acute myocardial infarction (4.3%) and post myocardial infarction angina (25.8%). Diseased vessels were left anterior descending (44.8%), right coronary artery (28.0%), left circumflex artery (25.5%), left main artery (0.9%) and saphenous vein grafts (0.8%). Initial case success rate was 93.5 per cent. Stent was implanted in 41.8 per cent of cases. In-hospital mortality rate was 1.2 per cent. Two patients (0.6%) developed Q-wave myocardial infarction (MI). Four patients (1.2%) required emergency bypass surgery (CABG). Major adverse cardiac events occurred in 6 patients (1.8%). Two hundred ninety one patients (85%) had complete follow-up data, mean follow-up time was 990 +/- 326 days. Twenty-one patients died (6.4%) but only 12 (3.5%) were cardiac in origin. Other cardiovascular events were non-fatal MI (1.2%), unstable angina (10.7%), congestive heart failure (4.6%), and chronic stable angina (41.1%). Target lesion revascularization by PTCA was done in 55 patients (16.9%) and CABG was performed in 22 patients (6.7%)PTCA can be performed with a high success rate and low in-hospital complications. Long-term outcomes are acceptable and comparable with Western data.

Background Lesions in small-diameter vessels ( Methods and Results We randomly assigned 351 symptomatic patients needing dilatation of 1 native coronary vessel between 2.3 and 2.9 mm in size to angioplasty alone (n=182) or stent implantation (n=169). The primary end point was angiographic restenosis at 6 months. Secondary end points included death, myocardial infarction, bypass surgery, and target vessel revascularization in hospital and at 6 months. There were no significant differences between groups in terms of major in-hospital complications. There was a trend toward fewer in-hospital events in the stent group (3% versus 7.1% in angioplasty group, P =0.076). Crossovers to stent occurred in 37 patients (20.3%). Repeat angiography at 6-month follow-up was performed in 85.3% of patients. Angiographic restenosis occurred in 28% of the stent group and 32.9% of the angioplasty group ( P =0.36). Target vessel revascularization was required in 17.8% versus 20.3% of patients ( P =0.54), respectively. Conclusions Stenting and standard coronary angioplasty are associated with equal restenosis rate in small coronary arteries. With a lower in-hospital complication rate, stenting may be a superior strategy in small vessels.

Aim: The aim of this study is to compare the safety, efficacy and durability of Sirolimus (SES), Paclitaxel (PES), Zotarolimus (ZES-R/ Endeavor Resolute), BiolimusA9 (BES), EPC capture (ECS) and Everolimus-eluting stent (EES) on the outcome of patients with left main coronary arteries (LMT) stenosis. Methods: A prospective analysis of 1127 LMT stenosis (321 SES, 277 PES, 129 ZES-R, 172 BES, 55 ECS, 173 EES) in six high volume Asian centers after successful stenting in LMT stenosis was performed. The study endpoints were 30 days major adverse cardiac events (MACE) and 12, 24, 36 and 48 months target lesion revascularization (TLR) and MACE in those 6 groups. Results: See table for clinical results. View this table: Conclusion: The use of drug-eluting stents in patients with LMT stenosis was safe with low acute complication. Patients treated with BES and EES showed lesser rate of restenosis compared with ZES-R and ECS.

Purpose: The aim of this study is to compare the safety and efficacy of Sirolimus (SES), Paclitaxel (PES), Everolimus-eluting stent (EES) and SeQuent™ Please, a drug-eluting balloon (DEB) on the outcome of patients with diffuse in-stent restenosis (D-ISR) after bare metal stent (BMS) implantation. Methods: A prospective analysis of 1078 patients with 1251 D-ISR lesions (427 SES, 363 PES, 232 EES and 229 DEB) in six high volume Asian centers after successful stent implantation (SES: LAD 45.7%, LCX 27.9%, RCA 26.4%) (PES: LAD 46.0%, LCX 22.9%, RCA 31.1%) (EES: LAD 50.0%, LCX 21.0%, RCA 29.0%) (DEB: LAD 54.0%, LCX 23.0%, RCA 23.0%) was performed. The study endpoints were major adverse cardiac events (MACE) and target lesion revascularization (TLR) at 12 and 24 months. Results: See table for clinical results. View this table: Conclusion: (1) The use of SES, PES, EES and DEB in patients with D-ISR seems to be favorable in terms of in-hospital clinical outcome. (2) Patients treated with DEB showed higher restenosis rate and TLR compared with DES.

The aim of this study was to evaluate the frequency, predictors and the clinical outcome of stent thrombosis after DES implantation and bare metal stent (BMS) implantation in Asian races. A total of 14,577 consecutive patients who underwent successful DES implantation (8,809 patients, 62% of the

Aim: The aim of this study is to compare the safety and efficacy of Sirolimus (SES), Paclitaxel (PES), Zotarolimus (ZES-R/ Endeavor Resolute), BiolimusA9 (BES), EPC capture (ECS) and Everolimus-elu...

Patients treated with renal failure have been reported having high incidence of mortality and other complications rate after PCI. Optimal treatment of PCI for renal failure patients with dialysis is still unknown. Aim: The aim of this study is to compare the safety and efficacy of Sirolimus (SES)

Aim: The aim of this study is to compare the safety and efficacy of Sirolimus-eluting stent (SES) and bare metal stent (BMS) on the outcome of patients with unprotected left main coronary arteries ...