ISSN:0009-7322    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background—The aim of this study was to use serial volumetric intravascular ultrasound to evaluate the effect of &ggr;-radiation on recurrent in-stent restenosis.Methods and Results—After successful reintervention, patients were randomized to receive either192Ir or placebo. Intravascular ultrasound studies with motorized pullback (0.5 mm/s) were performed immediately after irradiation and at 8-month follow-up in 70 patients. Paired volumetric analysis of the stented segment and of 5-mm proximal and distal reference segments was performed; this included measurements of the external elastic membrane, lumen, plaque and media (external elastic membrane minus lumen), stent, and intimal hyperplasia (stent minus lumen). Baseline proximal reference, stent, and distal reference measurements were similar in both groups. The changes in proximal and distal reference measurements of the external elastic membrane, plaque and media, and lumen areas were similar in both groups. However, the decrease in stented segment lumen volume was less in the192Ir patients than the placebo patients (–25±34 mm3versus –48±42 mm3;P=0.0225), and the increase in the volume of intimal hyperplasia in the stented segment was less in the192Ir patients than in the placebo patients (28±37 mm3versus 50±40 mm3;P=0.0352). When averaged over the length of the stented segment (32±13 mm versus 33±14 mm;P=0.9), the increase in mean area of intimal hyperplasia was 0.8±1.0 mm2in the192Ir group and 1.6±1.2 mm2in the control group (P=0.0065). Late stent-vessel wall malapposition was noted in one placebo patient and no192Ir patients.Conclusions—&ggr;-Radiation therapy can effectively prevent recurrent in-stent restenosis by inhibiting neointimal formation within the stent. At the stent edge, there were no significant differences between192Ir and placebo patients.

ISSN:0009-7322    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background—Atherosclerosis is associated with immune responses to oxidized lipoproteins and certain microorganisms, but the role of specific immunity has remained unclear.Methods and Results—To study the role of immunity in atherosclerosis, we crossed atherosclerosis-prone apoE—/–mice with immunodeficientscid/scidmice. The offspring showed a 73% reduction in aortic fatty streak lesions when compared with immunocompetent apoE–/–mice. Transfer of CD4+T cells from apoE–/–to immunodeficient apoE–/–/scid/scidmice increased lesions by 164%. This was associated with the infiltration of transferred T cells into lesions, increased circulating interferon-&ggr; levels, and increased I-A expression in lesions.Conclusions—CD4+T cells carry disease-promoting immunity in atherosclerosis.

ISSN:0009-7322    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background—In the EPILOG trial (Evaluation in PTCA to Improve Long-term Outcome with abciximab GP IIb/IIIa blockade), abciximab administered with weight-adjusted heparin diminished the risk of ischemic complications within 30 days by 56% among patients undergoing percutaneous coronary revascularization, without increased bleeding complications.Methods and Results—A prospective economic assessment was performed in the 2792 patients enrolled in EPILOG. Patients were randomized to receive placebo with standard-dose weight-adjusted heparin, abciximab with low-dose weight-adjusted heparin, or abciximab with standard-dose weight-adjusted heparin during percutaneous coronary intervention. Hospital billing data for the baseline hospitalization were collected for 2581 patients (92.4% of total) and imputed for the remainder, with physician fees estimated from the Medicare Fee Schedule. For the baseline hospitalization, medical costs (hospitalization and physician fees) averaged $9632 for the placebo arm compared with $8758 (P=0.005) and $9092 (P=0.176) for the abciximab with low-dose and standard-dose heparin arms, respectively. Inclusive of average drug cost ($1454 to $1457), the net incremental baseline cost of these 2 abciximab strategies was $583 with low-dose weight-adjusted heparin and $914 with standard-dose weight-adjusted heparin. During 6-month follow-up, average hospital costs were not significantly different in the 3 treatment groups; cumulative net incremental costs were $1236 and $1268 in the abciximab with low-dose and standard-dose heparin groups, respectively.Conclusions—Treatment with abciximab and low-dose, weight-adjusted heparin during percutaneous coronary revascularization reduces ischemic events and associated costs, thereby offsetting some of the cost of the drug. The suppression of bleeding complications associated with this agent by heparin dose reduction optimizes the economic attractiveness of this treatment strategy.

ISSN:0009-7322    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background—Coronary stenting improves outcomes compared with balloon angioplasty, but it is costly and may have other disadvantages. Limiting stent use to patients with a suboptimal result after angioplasty (provisional angioplasty) may be as effective and less expensive.Methods and Results—To analyze the cost-effectiveness of provisional angioplasty, patients scheduled for single-vessel angioplasty were first randomized to receive primary stenting (97 patients) or balloon angioplasty guided by Doppler flow velocity and angiography (523 patients). Patients in the latter group were further randomized after optimization to either additional stenting or termination of the procedure to further investigate what is “optimal.” An optimal result was defined as a flow reserve >2.5 and a diameter stenosis <36%. Bailout stenting was needed in 129 patients (25%) who were randomized to balloon angioplasty, and an optimal result was obtained in 184 of the 523 patients (35%). There was no significant difference in event-free survival at 1 year between primary stenting (86.6%) and provisional angioplasty (85.6%). Costs after 1 year were significantly higher for provisional angioplasty (EUR 6573 versus EUR 5885;P=0.014). Results after the second randomization showed that stenting was also more effective after optimal balloon angioplasty (1-year event free survival, 93.5% versus 84.1%;P=0.066).Conclusions—After 1 year of follow-up, provisional angioplasty was more expensive and without clinical benefit. The beneficial value of stenting is not limited to patients with a suboptimal result after balloon angioplasty.

ISSN:0009-7322    

出版商:OVID    

年代:2000

数据来源: OVID