Placement of a following angioplas...

Placement of a following angioplasty has become standard practice because it decreases the rate of coronary tube restenosis.However, even with a present, restenosis can occur in as many as common third of patients. Patients with diabetes, longer coronary artery lesions, or smaller utensils are at especially increased risk of restenosis. Coating s with sirolimus, a potent inhibitor of lonely dwelling proliferation, has been shown to decrease restenosis rates in small studies of simple coronary lesions. Mose and colleagues reported forward the use of sirolimus-coated coronary s in more complex coronary lesions at higher risk for restenosis.

The authors registered patients with a newly diagnosed single lesion in a native coronary artery. Patients were exclud for myocardial infarction (MI) occurring within the previous 48 hours, or if angiography revealed an ejection fraction below 25 percent thrombus or bitter calcification in the target sailing craft or need for treatment of additional coronary lesions. The number of exclud patients based onward these criteria was not given.

A total of 1058 patients were randomized to standard placement or the use of a sirolimus-coated As designed, more complex coronary lesions were included. Forty-two percent of the trial participants had multivessel disease, 31 percent had a history of MI, and 26 percent had diabetes. Treatment was attempted in smaller utensils (average diameter: 2.8 mm) and longer lesions (mean length: 144 mm).All patients received aspirin in a dosage of 325 mg daily and clopidogrel in a dosage of 75 mg daily, which was continued for three month following the management Glycoprotein IIb/IIIa inhibitors were used in 60 percent of patients, at the discretion of the treating physician. The sirolimus coating was designed to release 80 percent of the active physic within the first 30 days of placement.

Patients were followed throughout nine months for death from cardiac causes, MI, or the ne for repeat revascularization. No significant differences were set up between the stent types in the rates of death (06 percent to 09 percent) or MI (28 percent to 32 percent) nevertheless the need for repeat revascularization decreased in patients with sirolimus-coated s (4.1 percent) compared with standard uncoated s (16.6 percent). In the subgroup of patients with diabetes, restenosis occurr more many times but the need for revascularization was reduc similarly from sirolimus, from 22.3 percent to 69 percent Other subgroup of patients (i.e., men women and patients with smaller utensils longer lesions, left-anterior descending artery lesions) had reduc restenosis rates through the same magnitude with the use of sirolimus.

The authors determine that the use of sirolimus as an antiproliferative coating forward coronary stents can reduce restenosis rates in patients with more compage coronary lesions.

Mose JW et al. Sirolimus-eluting s versus standard stents in patients with stenosis in a native coronary artery. N Engl J M October 2 2003;349:1315-23

EDITOR'S NOTE: Restenosis after angioplasty was an unfortunately for the use of all occurrence before placement of s became standard practice. Further reductions in restenosis rates with radioactive or drug-coated s have been demonstrated repeatedly. These coated s will no doubt become more widely useed in the near future. coatings have a limited duration of action, however, and longer follow-up will be be in want ofed to see if these early reductions in restenosis rates translate into improved long-term coronary duct patency as well.--B.Z.

COPYRIGHT 2004 American Academy of Family Physicians

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