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INTRODUCTION: we investigated the outcomes of stenting with overlapping drug-eluting stents (DES) versus overlapping stenting with a combination of drug-eluting and bare metal stents (BMS) in very long coronary lesions (≥ 25 mm). METHODS AND RESULTS: fifty-two patients treated with either overlapping DES-DES (n = 22) or DES-BMS (n = 30) were selected from a registry of 588 patients with very long coronary lesions. Patients with acute myocardial infarction (MI) within the preceding 48 hours were excluded. The DES-DES combination was more frequently used for longer lesions compared with the DES-BMS group (47.95 ± 9.25 vs 39.98 ± 9.15 mm, p = 0.003). Left anterior descending artery lesions were also more frequently treated with the DES-DES combination (95.5 vs 66.7%, p = 0.02). In four patients in the DES-BMS group, overlapping stents were used for the coverage of dissections. Peri-procedural non-Q-wave MI occurred in one patient in the DES-BMS group. On follow up, only one case of non-fatal MI occurred in a patient with overlapping DES-DES. CONCLUSION: overlapping a BMS in the proximal part of a long DES instead of exclusive deployment of two or more overlapped DES seems to be a safe and feasible therapeutic strategy in our practice.

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AIM: Exercise capacity after training has been reported to improve after cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). The purpose of this study was to evaluate the effect of different sessions of an exercise-based CR program on exercise capacity in CAD patients after elective percutaneous transluminal coronary angioplasty (PTCA). METHODS: In a university hospital, 440 patients who were enrolled in an exercise-based CR program (phase 2) after elective PTCA, were retrospectively evaluated. Two hundred-eighty-six subjects were categorized based on the completion of CR sessions (group A, B and C completing 5, 10 and 24 sessions, respectively). The main outcome measures were exercise training energy expenditure (ETEE) and treadmill velocity of first and last session of CR. Pearson's chi(2) test, Kruskall-Wallis test, paired Student's t test and multivariate analysis were used. RESULTS: All patients showed significant improvements in ETEE and treadmill velocity from baseline to follow-up sessions. A significant group effect on exercise parameters was detected between all the three CR groups (P<0.0001). On follow-up, the ETEE and treadmill velocity had statistically significant correlation with the number of completed sessions, age and gender (P<0.001). CONCLUSION: The present study indicated that improvement in exercise capacity occurs in both gender from baseline to the last session, regardless of clinical characteristics of patients with PTCA. When controlled for other factors, calorie expenditure and treadmill velocity was independently associated with the number of completed sessions, age and gender.

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BACKGROUND: Direct stenting without balloon dilatation may reduce procedural costs and duration, and hypothetically, the restenosis rate. This study was designed to compare the in-hospital and long-term outcomes of direct stenting (DS) versus stenting after pre-dilatation (PS) in our routine clinical practice. METHODS: The 1 603 patients treated with stenting for single coronary lesions were enrolled into a prospective registry. Patients with acute myocardial infarction (MI) within the preceding 48 hours, and those with highly calcified lesions, total occlusions, or a lesion in a saphenous graft were excluded. The baseline, angiographic and procedural data, in-hospital outcomes and follow-up data were recorded in our database and analysed with appropriate statistical methods. RESULTS: Eight hundred and fifty-seven patients (53.5%) were treated with DS and 746 (46.5%) underwent PS. In the DS group, lesions were shorter in length, larger in diameter and had lower pre-procedural diameter stenosis. Type C and diffuse lesions and drug-eluting stents were found less often (p < 0.001). With univariate analysis, dissection and non- Q-wave MI occurred less frequently in this group (0.2 and 0.6% vs 3.9 and 2.1%, p < 0.001 and p = 0.01, respectively). However, the cumulative major adverse cardiac events (MACE) did not differ significantly (4.9 vs 4.6%, p = 0.79). With multivariate analysis, direct stenting reduced the risk of dissection (OR = 0.07, 95% CI: 0.01-0.33, but neither the cumulative endpoint of MACE (OR = 1.1, 95% CI = 0.58- 2.11, p = 0.7) nor its constructing components were different between the groups. CONCLUSIONS: Direct stenting in the real world has at least similar long-term outcomes in patients treated with stenting after pre-dilatation, and is associated with lower dissection rates.

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BACKGROUND: Reduced ejection fraction (EF) has previously been shown to be a risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). However, with the advent of stents, procedural complications and restenosis rates have reduced dramatically. The aim of this study was to assess the association between left ventricular (LV ) ejection fraction and in-hospital and longterm outcomes using a prospective registry. METHODS: After exclusion of patients with acute myocardial infarction (MI) and those with missing data on left ventricular ejection fraction, 2 030 patients undergoing PCI between March 2002 and 2004 remained in our prospective registry. Patients were divided into three categories: group 1: EF or= 50% (n = 1 469). The frequency of in-hospital and follow-up outcomes between groups was compared using appropriate statistical methods. RESULTS: Stents were used for over 85% of the patients in each group. The mean EF +/- SD in the lowest to highest EF groups was 35.8 +/- 5.4%, 45.5 +/- 1.6% and 57 +/- 5.7%, respectively. The angiographic and procedural success rates were 91.8, 92.1 and 94.1%, (p = 0.16); and 91.1, 90.3 and 92.9%, (p = 0.09), respectively. The respective cumulative major adverse cardiac events (MACE) and cardiac death rates at follow-up were 5.8, 2.2 and 3.3% (p = 0.04) and 2, 0.4 and 0.3% (p = 0.02), respectively. The hazards ratio (95% CI) for MACE and cardiac death in the lowest versus highest EF groups were 2.07 (1.03-4.16) and 5.49 (1.29-23.3). CONCLUSIONS: Patients with significant left ventricular dysfunction had higher long-term major adverse cardiac events and cardiac death rates. Even the use of newer techniques such as stenting did not compensate for this.

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