Klinische und angiographische Akut- und Langzeitergebnisse nach direkter Stentimplantation bei Patienten mit symptomatischer koronarer Herzkrankheit
The study presented the acute- and long- time results of patients with coronary artery disease who undergo direct stent implantation. The values are resulted on one side from digital quantitative coronary coronarangiography (QCA) and on the other side from the clinical symptoms classified by the Canadian Cardiovascular Society (CCS) and the New York Heart Association (NYHA).Angiographic results:The proximal, mean and distal reference diameter did not vary between the various measurements. The minimal lumen diameter (MLD) increased from 0.8 (SD 0.4) mm up to 2.5 (SD 0.8) mm. This corresponds with an acute gain of 1.6 (SD 0.8) mm. At the follow-up was the value of MLD 1.6 (SD 0.8) mm, resulting a late loss of 0.5 (SD 0.9) mm. The net gain was 1.1 (SD 0.7) mm. The mean diameter of stenosis correlates similar to the MLD. The length of stenosis was quantified with 9.5 (SD 4.1) mm. The mean ballon diameter was 3.0 (SD 0.4) mm. The mean diameter of stenosis after intervention was calculated with 14%, after round about 6 months with 28%. In 46 cases (28%) a new stenosis in the stent area could be detected. In a group of 20 patients (43%) remained a restenosis (> 50% diameter of stenosis).Clinical results:Our patients had a lot of angiographic characteristics which come along with an increased risk of a worse outcome. Especially this relates to the high incidence of multivessel-disease and complex with partly thrombus containing stenosis (type B2 / C). Despite of this, the results from the digital quantitative coronarangiography and the clinical outcomes showed a very good angiographic and clinical output after direct stent implantation. 92% of the patients (n= 151) were significantly relieved of their symptoms and 1/3 was completely without any symptoms.The data analysis showed that the clinical outcomes of the patients differed often from the angiographic results of the therapied lesions. The target vessel minimal lumen diameter (MLD) of the patients with permanent angina pectoris or dyspnoe symtoms did not differ from those who had not any clinical symptoms (2.0 (SD 0.7) mm vs. 2.0 (SD 0.7) mm). 70% of these patients had a multivessel-disease. All stents with one exception offered an excellent angiographic result (mean diameter stenosis of 32%) at the follow-up.28 patients (17%) were hospitalised because of cardiological reasons, 86% had symptoms of angina pectoris. In 25 cases the follow-up was brought forward. 80% out of it had an excellent result of the stent (mean diameter of stenosis 30.4%). In case of 16 patients the angina pectoris symptoms were caused by stenosis outside of the target vessel, in 11 cases occured a Re-PTCA, in the other cases was a drug orientated concept established.In the meantime in 4 cases (2%) happened an acute coronary syndrome (ACS). In 3 of it were the target vessel involved, but only by one patient was the reason located in the stent. In the other cases the ACS was caused by a subtotal stenosis distal the direct implanted stent (>/=5 mm). In more than one third of the cases in which the follow-up was brought forward, a reintervention happened. But only by 8% of the patients, who came to the regular follow-up, was a new intervention necessary. In total, at the regular follow-up in 25 cases (15%) a reintervention occured. By 13 Patienten (8%) was the target vessel (TVR) involved.At the analysis of potential predictors, which favoured restenosis, only some trends could be found. These correlated with the aspects which are described in the literature. For example long or complex lesions (type B / C) have promoted effects to the process of restenosis. The same for diabetes mellitus.Conclusion:The studie showed that in a great collective of stenosed lesions a very good angiographic and clinical outcome could be achieved.But the restenosis is independent from the kind of the stent implantation the Achilles tendon of the coronary angioplastie.
info:eu-repo/classification/ddc/610, Implantation, Koronarendoprothese, Stent, Kardiologie, Angiokardiographie, Koronarographie, Koronare Herzkrankheit, Kardiovaskuläre Krankheit, Medizin, Direkte Stentimplantation, Direktes Stenting, Primäres Stenting, Kardiovaskuläre Risikofaktoren, Direct stenting, direct stent implantation, primary stenting, cardiovascular riskfactors
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