148
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S-213￭
Efficacy and safety of the sirolimus-eluting stent versus the zotarolimus-eluting stent versus the paclitaxel-eluting stent.
광주 보훈 병원 순환기 내과, 경희대학교병원, 전남대병원, KAMIR 소속병원
*임철환, 강원유, 김연화, 안혜미, 황선호, 김 원, 김 완, 홍영준, 안영근, 정명호, 강정채, KAMIR 연구자
Background and Objectives: Drug-eluting stents has been used to treat in patients with coronary artery diseases and shown to reduce rate of restenosis. We compared the efficacy and safety of the sirolimus-eluting stent (SES) versus the zotarolimus-eluting stent (ZES) versus the paclitaxel-eluting stent (PES) in patients with acute coronary syndromes. Methods: A postspective, multicenter, randomized trial was conducted to evaluate the safety and efficacy of SES (n=2357), ZES (n=283) and PES (n=1771) in 4423 patients undergoing primary percutaneous revascularization. The primary end point was composite of major adverse cardiac events at 6 months and 12 months: all-cause death, cardiac death, myocardial infarction and clinically driven target vessel revascularization. Results: At 6 months, the primary endpoint had occurred in a lower patients treated with SES than ZES (8.7% vs. 17%, HR 0.46, 95% CI 0.33-0.65, p<0.001), SES than PES (8.7% vs. 11.3%, HR 0.74, 95% CI 0.60-0.91, p=0.006) and higher patients treated with ZES than PES (17% vs. 11.3%, HR 1.61, 95% CI 1.14-2.25, p=0.005). At 12 months follow-up, this difference was similar results. SES vs. ZES (11.9% vs. 21.4%, HR 0.49, 95% CI 0.36-0.67, p<0.001), SES vs. PES (11.9% vs.
14.8%, HR 0.78, 95% CI 0.65-0.93, p=0.007), ZES vs. PES (21.4% vs. 14.8%, HR 1.57, 95% CI 1.15-2.13, p=0.004). All cause-motality at 12 months was SES vs. ZES (2.7% vs. 6.5%, HR 0.40, 95% CI 0.23-0.68, p<0.001), SES vs. PES (6.5% vs. 3.8%, HR 1.75, 95% CI 1.03-2.97, p=0.03), ZES vs. PES (2.7% vs. 3.8%, HR 0.71, 95% CI 0.50-1.00, p=0.53). Conclusion: Compared with ZES and PES, SES had superior clinical outcome. Key words Acute coronary syndrome; Drug-eluting stents
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S-214￭
Reverse Controlled Antegrade and Retrograde subintimal Tracking in chronic total occlusion of right coronary artery
광주보훈병원 심혈관센터1, 경희대학교병원 순환기내과2
*김연화
1, 임철환
1, 안혜미
1, 김 원
2, 강원유
1, 황승환
1, 황선호
1, 김 완
1INTRODUCTION: Percutaneous coronary intervention (PCI) of Chronic total occlusion (CTO) is remained for challenge. Passage failure of guidewire is still remained most common reason for PCI failure in CTO. Intravascular ultrasound study (IVUS) can give adjuctive information to detect the area of occlusion in selective cases from adjacent side branches or from the false lumen and the anatomical information about distal segment of total occluded coronary artery when dye could not penetrate. We report the educational case of successful PCI of CTO of RCA lesion with reverse controlled antegrade and retrograde subintimal tracking and assistance of IVUS. CASE: This case involves 68-year-old man had a history of hypertension, Old myocardial infarction. He was undergone percutaneous coronary intervention (PCI) for LAD, LCX 17 months ago, We performed coronary angiography (CAG) for follow up via right trans radial artery and trans femoral artery approach (bilateral injection) revealed no ISR in LAD and LCX, but showed chronic total occlusion in p-RCA(C,100%,0) with grade III collateral flow. In this case, IVUS study in addition to angiography was performed to evaluate CTO lesions because of previous failure of intervention for proximal RCA. And, we finally considered it was not tapered stump but conus branch. (And it looked as tapered stump.) We pass the wire via septal branch to m-d-RCA (retrograde approach). After successful wiring via retrograde approach (reversed CART) using 2.5mm balloon for p-RCA and m-RCA(C,95%,III). And then, we deployed 3.5x28mm cypher stent for m-RCA and 3.5x33mm Cypher stent for p-RCA. Final angiogram showed good distal flow without residual stenosis. After PCI, the patients had no complication, such as increased cardiac enzyme, creatinine, chest pain, so we decided that medical therapy and follow up CAG in 6 months later. CONCLUSIONS: If previous attempts to cross the totally occluded lesion from anterograde approach fail, the retrograde approach from collateral should be firstly considered. In futrure, development of IVUS or other diagnostic study would elevate the success rate of PCI with detection of true lumen.
