IntroductionThe aim of our study was to evaluate the clinical efficacy and safety of unprotected LMS percutaneous interventions (PCI) in a non-surgical centre.MethodsThe data on LMS PCI cases performed over 41 months was collected from local database and discharge summaries. Major adverse cardiovascular events (MACE) were also recorded at 6 and 12 months.ResultsA total of 147 patients with multiple risk factors had unprotected LMS PCI performed. Demographics were: 73% males with an average age of 70 years. 48% were elective procedures, 31% NSTEMI and 15%PPCI. Bail out stenting was required in 1%. Over 70% of procedures were performed transradially. The average EURO score was 2.89%. The anatomical distribution was: 47% distal LMS, ostial 23% and 22% mid-LMS. Of the lesions 51% involved only the LMS. Additional imaging was used in 41% of PCIs. The mean Syntax score was 34.4. 74% patients had drug eluting stents, followed by bare metal stents (8%), drug eluting balloons (8%) and combo stents. 5% of patients were in cardiogenic shock and 6% had Intra-aortic balloon pump inserted. Procedural success was reported in 96.6% of cases. In-hospital MACE was 3.4%. The MACE rates for 6 months and 12 months were 10.2% and 13.6% respectively. There were 4 in-hospital deaths recorded (2.7%). The study revealed a procedural success of over 95%. The in-hospital MACE was 3.4% and the 12 month MACE rate was comparable to the reported data.ConclusionThis study demonstrates that PCI in LMS lesions performed in a non-surgical centre is both safe and effective.

Bisoprolol is a new cardioselective beta-blocker with a long half-life. The efficacy of once daily bisoprolol (10 mg) and atenolol (100 mg) was assessed in 20 patients with stable angina using a placebo controlled double-blind randomized crossover protocol. Efficacy was assessed by computer assisted treadmill exercise testing with monitoring of leads CM5 and CC5, carried out 22-24 h after the last dose. The mean +/- SEM exercise time on placebo was 6.5 +/- 0.4 min increasing to 7.8 +/- 0.5 min on bisoprolol (P less than 0.001) and 8.6 +/- 0.6 mins on atenolol (P less than 0.001). The time to 1 mm ST depression in CM5 and CC5 was also prolonged significantly with both drugs. The mean basal resting heart rate of 84 +/- 4 bpm decreased to 63 +/- 2 bpm on bisoprolol (P less than 0.001) and 64 +/- 3 bpm on atenolol (P less than 0.001), with a significant decrease in the peak exercise heart rate seen with both drugs (P less than 0.001). The peak rate-pressure product was 175 +/- 8 after placebo, 146 +/- 7 (P less than 0.001) with bisoprolol and 149 +/- 5 (P less than 0.001) after atenolol. One patient was withdrawn because he suffered a myocardial infarction. Eighteen patients were prescribed bisoprolol 10 mg once a day for 6 weeks and an exercise test was performed at the end of this period. Bisoprolol retained its efficacy at the end of this period and was well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)

This randomized, double-blind, parallel study compared the anti-anginal effects of nicorandil and atenolol in 37 patients with exercise-induced angina pectoris. At the end of a single-blind placebo period, patients were randomized and received either atenolol 50 mg o.d. or nicorandil 10 mg b.d. for 3 weeks. On the third week, the dosage was increased (nicorandil 20 mg b.d. or atenolol 100 mg o.d.) for the final 3-week period. Treadmill exercise tolerance tests were performed immediately before and 2 h after dosing at the end of the placebo period, and at the end of the third and sixth week of active treatment. Demographic characteristics and exercise performance with placebo were comparable between both treatment groups, and at the end of the treatment periods a significant improvement in exercise time was observed: an increase in the time to peak exercise of 1.33 +/- 0.29 min (mean +/- standard error of the mean) in atenolol-treated patients (P < 0.001), and of 1.47 +/- 0.40 min (P < 0.005) in nicorandil-treated patients. While the anti-anginal activity of the two drugs was comparable, their effects on the rate-pressure product heart rate x systolic blood pressure were clearly different; atenolol induced a decrease at peak exercise, but this parameter was not changed or was slightly increased with nicorandil. One patient with severe three-vessel disease died suddenly after 3 days of treatment with nicorandil 10 mg twice daily. The most frequent adverse effect in both groups was headache, which led to discontinuation of one patient in the atenolol group and of five patients in the nicorandil group.(ABSTRACT TRUNCATED AT 250 WORDS)

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