Research On Clinical Application Of Post-dilatation For Elderly Patients With Coronary Artery Calcification Lesion

Objective Elderly patients with coronary artery calcification lesion undergone Percutalleous Coronary Intervention(PCI) were divided into two groups by PCI approach which were conventional deployment(CD) group and post-dilatation(PD) group.Drug-Eluting Stents were implanted in the tow groups. Procedure outcome and stent thrombosis,stent restenosis, major adverse cardiac events (MACE) were compared between the two groups and evaluate the clinical efficacy and safety of drug-eluting stents post-dilatation being applied to elderly patients with coronary artery calcification lesion.Methods The angiographic success of 107 elderly patients with coronary artery calcification lesion hospitalized in our hospital were randomly divided into tow groups by PCI approach which 52 cases were conventional deployment(CD) group, and 55 cases were post-dilatation deployment (PD) group.CYPHERTM was implanted in the tow groups.1.PCI Coronary angiography was porformed by the radial artery or femoral artery approach for all patients. We finish coronary angiography and select the appropriate type of stents according to vascular lesions. Stents were implanted and achieved success criteria for angiography by conventional method. On this basis, the non-compliant balloon was placed in the stent and expansed at the 14-20atm pressure with 2-4 times in PD group.2.Items to be observed Lesion location , calcification degree, type of diseases,stent version,deployed pressure,type of postdilatation balloons, flow grade, spend time and success rate of PCI,whether dissection and perfbration existed ,vessel diameter and vessel area before and after stent deployment.3.Clinical follow-up and repeated angiography The major adverse cardiac events (MACE) including acute myocardial infarction,revascularization and death within one week,one month and six months after PCI were recorded through clinical seivices and telephone.Repeated angiography would carry out six months after PCI and angiograms be analyzed.Results 1.There were no singificant differences in the baseline characteristics between tow groups.2.PCI was porformed with 157 lesions in CD group and 178 Lesions in PD group.There were no significant differences in vessel numbers,lesions locations and DES numbers between two groups.3.Luminal minimal diameters and absolute luminal diameter gain after PCI in PD group were 1arger than those in CD group.Before PCI, there were no significant difference in lesion size, lesion stenosis and stent diameter between tow groups. Immediately lumen diameter was significantly larger than the control group [(2.51±0.43)mm vs(2.12±0.37)mm,P<0.05]. Both groups are no significant difference in complications. The luminal minimal diameters six months later in PD group were larger than that in CD group[(2.75±0.41)mm vs(2.37±0.28)mm,P<0.05].4.All patients completed 6 months clinical follow-up, Stent thrombosis, restenosis rate and cardiovascular adverse events in PD group were significantly reduced compared with control group[(1.82% vs 11.54%, P<0.05);(2.94% vs 18.75%, P<0.05);(5.45% vs 26.92%, P<0.05)].Conclusions 1.A noncompliant balloon post-dilation after DES implantation in elderly patients with coronary artery calcification lesion can get better immediate effects and no more complications.2.A noncompliant balloon post-dilation after DES implantation in elderly patients with coronary artery calcification lesion is safe and effective.It can reduce stent thrombosis, in-stent restenosis rate and major adverse cardiac events.