الفهرس 
Acute Coronary SyndromesOnly 14 pages are availabe for public view
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Abstract
Treatment for very small vessel atherosclerosis with revascularization procedures remains a challenge in daily clinical practice.
The use of intracoronary metallic stents has improved results over balloon dilatation alone and has become standard care for patients undergoing PCI. However, in-stent restenosis, leading to recurrence of symptoms, has been the major drawback of bare metal stents (BMS). Drug-eluting stents (DES) were introduced in an attempt to overcome this problem and, due to the improved effectiveness in preventing restenosis, DES implantation has rapidly grown to up to 80% of cases in some countries.
In this study, we aimed to compare cobalt-chromium BMS with DES in small artery stenosis in non-diabetic patients with ACS according to patients’ clinical characteristics, acute and late results.
The present study was conducted on 100 non-diabetic patients admitted with acute coronary syndrome and referred to Cath. Lab for primary PCI to small artery stenosis with diameter less than 3 mm and length less than 25 mm whether BMS or DES according to the decision of the physician. Patient with multi vessels disease, diabetic patients, lesions longer than 25 mm, lesions with diameter more than 3 mm, Post CABG and restenotic lesions were excluded.
According to type of stent used in intervention, the patients were classified into:
• DES group: included 50 patients with drug eluting stents to treat de novo coronary lesions.
• BMS group: included 50 patients with cobalt chromium stents to treat de novo coronary lesions.
All patients subjected to:
1- Complete history taking.
2- Physical examination.
3- Laboratory investigation including creatinine measurement.
4- ECG analysis.
5- Echocardiography (ejection fraction by Biplane Simpson’s method)
6- PCI by drug eluting stents and cobalt chromium stents to small artery stenosis with diameter less than 3mm and length less than 25mm.
7- Follow-up by coronary angiography to detect presence of instent restenosis within 6 months.
Results:
In the present study, mean age of all studied group was 49.6 ± 9.3 years. 70 patients (70%) were males. 43 patients (43%) were hypertensive, 55 patients (55%) were smokers, 54 patients (54%) had dyslipidemia, and 41 patients (41%) were obese. +ve family history was in 36 patients (36%).
The present study showed that 45% of patients had inferior lesion with 78%, 19% of patients had killip class 1 and 2 respectively while only 3% of patients had killip class 3. The median of heart rate and DBP were 80, while the median of SBP was 120. And, the mean ± SD of EF and s. creatinine were 57.5 ± 6.8% and 0.97 ± 0.19 mg/dl respectively.
The current study also showed that the culprit vessel was LAD in 35% of all patients, LCX in 21% and RCA in 19% with the lesion type A presented in 69% of patients. The median of lesion and stent length were 14 and 18 mm respectively with stenosis severity 90% while the stent diameter was 2.75 mm.
Regarding clinical outcomes during the follow-up of the whole study population, 5% of patients had composite end point, ISR and MI after 6 months of follow up while 4% of patients had TVR and 1% of patients had CABG. Only one patient died in our study.
The current study showed that there was no significant difference between DES and BMS group regarding age, risk factors, ECG and clinical data, EF and s. creatinine.
Also, there was no significant difference between DES and BMS group regarding coronary angiographic, procedural data and clinical outcomes during follow up.