الفهرس 
ATHEROSCLEROSISOnly 14 pages are availabe for public view
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Abstract
Coronary artery bypass grafting (CABG) has long been the definitive, nevertheless aggressive therapeutic approach for the treatment of patients with multi-vessel coronary artery disease, On the other hand, continuous improvement of devices and percutaneous techniques in interventional cardiology has led from limited treatment of single, simple lesions to the extensive management of multiple and severely complex stenosis.
Cobalt chromium stents in comparison with stainless steel has a higher radial strength and radio-opacity. This allows for the production of thinner struts with a similar radiological visibility which may decrease the incidence of restenosis and may be suitable for patients with coronary artery disease.
This study was conducted in order to compare between Cobalt chromium stent versus stainless steel bare metal stents in management of patients with multi-vessel coronary artery disease.
Two groups of patients were enrolled in this clinical trial; each included 20 patients with multi-vessel coronary artery disease candidate for percutaneous coronary intervention, There was no significant difference between the two groups regarding their mean age, their sex distribution, and history of CAD or risk factors for coronary artery disease (P > 0.05).
All patients included in the study were subjected to; full history taking complete general and local examination of the heart, 12-lead ECG, and stent implantation with or without balloon pre-dilatation.
All patients received aspirin 300 mg loading dose and then 150 mg/day indefinitely, clopidogrel was given as 300 mg loading dose at time of hospital admission for patients whom elective PCI was done, then 75 mg daily for at least 1 year, At the start of the procedure a bolus of weight-adjusted unfractionated heparin was administered intra-arterially to achieve an activated clotting time (ACT) of >300 seconds, or 200 to 250 seconds when platelet glycoprotein IIb/IIIa inhibitor used.
All procedures were performed according to standard techniques, and the final interventional strategy was left entirely to the discretion of the operator. After the procedure, all patients remained in the hospital for at least 24 hours. In-hospital outcomes were reviewed and reported, Clinical follow-up was done after 1, 3 and 6 months. Patients with chest pain on follow up and had a positive clinical exercise testing underwent another coronary angiography.
The occurrence of major adverse cardiac events (MACE) defined as death (all deaths are considered cardiac unless there is documentation to the contrary), non-fatal myocardial infarction (ST segment elevation & non ST segment elevation myocardial infarction), clinically driven target lesion revascularization or target vessel revascularization (TVR) (CABG or repeat PCI).
Descriptive statistics were done including mean, standard deviation and incidence, Comparison between the two groups was done using chi-square test and paired student’s t-test, P < 0.05 was considered significant.
Two groups of patients were enrolled in this clinical trial; each included 20 patients with multi-vessel coronary artery disease candidate for percutaneous coronary intervention. There was no statistically difference between the two groups regarding the total number of arteries which underwent PCI (43 arteries in cobalt chromium group versus 42 arteries in stainless steel bare metal stent group), mean reference vessel diameter(3.1mm in cobalt chromium group versus 2.97mm in stainless steel bare metal stent group P > 0.05), lesion length(22.9mm in cobalt chromium group versus 19.1mm in stainless steel bare metal stent group P>0.05) or the prevalence of calcific lesions(4.6% in cobalt chromium group versus 4.6% in stainless steel bare metal stent group P > 0.05).
Attempt direct stenting was done in 37/43 lesions (86%) of the cobalt stent groups and in 34/42 lesions in the SS group. The difference was not significant (P > 0.05). Failed direct stenting was significantly higher in the stainless steel bare metal stent group versus the cobalt chromium stent group (P < 0.05). All patients of the two groups underwent stenting successfully without major procedural complications. There was no statistically significant difference between the two groups regarding the balloon diameter, balloon length, balloon pressure, stent diameter, stent length, stent pressure and the post procedure TIMI flow (P > 0.05).
Follow up after 6 months showed that death occurred in 1 patient (5%) of both groups. STEMI occurred in 1 patient (5%) of the Cobalt chromium stent group and in 2 patients (10%) of the SS stent group, NSTEMI occurred in 1 patient (5%) of the Cobalt stent group and in 2 patients (10%) of the stainless steel bare metal stent group.
There was no significant difference between the two groups regarding the in-hospital and 6 months individual events, the overall incidence of Major Adverse Cardiovascular outcome occurred in 3 patients (15%) of the Cobalt chromium stent group versus 5 patients (25%) of the stainless steel bare metal stent group. The difference between the two groups was statistically significant (P<0.05).