Drug eluting stents are useful in vessels < 2.75 mm diameter ▸

Initial trials of drug eluting stents were in medium size vessels (average 3 mm), but restenosis rates are highest in small vessels. They are also technically difficult to graft. Ardissino and colleagues randomised 257 patients to treatment with either a sirolimus eluting stent (129) or uncoated stent (128). Eligible patients included those with stable angina or acute coronary syndromes found to have a single, uncomplicated, 50–99% stenosis of a vessel < 2.75 cm in diameter. After eight months of follow up, 9.8% of those receiving a sirolimus eluting stent, compared to 53.1% of those receiving a uncoated stent, showed evidence of restenosis (> 50%) (relative risk (RR) 0.18, 95% confidence interval (CI) 0.10 to 0.32; p < 0.001). Furthermore, fewer patients randomised to sirolimus stents experienced major cardiac events. The authors conclude that the use of sirolimus eluting stents in these small arteries likely represents a significant advance, and suggest that extended follow up is carried out.

▴ Ardissino D, Cavallini C, Bramucci E, et al. Sirolimus-eluting vs uncoated stents for prevention of restenosis in small coronary arteries. JAMA2004;292:2727–34.OpenUrlCrossRefPubMedWeb of Science

Even a minor troponin rise is bad for your health ▸

In 1024 patients with acute coronary syndrome, treated with revascularisation within 24 hours (mean six hours), troponin T remained of prognostic significance. In-hospital mortality was 0.7% (3/449) in patients with troponin T concentrations < 0.010 μg/l, 2.0% (4/197) in those with concentrations from 0.010–0.035 μg/l, 3.2% (6/186) in those with concentrations from 0.035–0.229 μg/l, and 4.7% (9/192) in patients with concentrations > 0.229 μg/l. Cumulative two year mortality rates were 2.8%, 8.0%, 10.5%, and 14.8% from the lowest to highest troponin T groups (p < 0.001). In contrast, the risk of non-fatal myocardial infarction assumed an inverted U shaped curve and was lower in the lowest and highest troponin T groups. Previous studies have …