الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
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Abstract
This was a prospective, single-center, randomized comparative study designed to evaluate the use of cobalt chromium versus stainless steel bare metal stents in patients undergoing PCI as regard the short and intermediate term tolerance, safety, and efficacy.
The study was conducted on 240 patients presented with stable angina, unstable angina, or prior MI at Sohag University Hospital, Internal medicine department, Cath. Lab. unit. from May, 2011 to April, 2013.
The patients divided into two groups:
• Group (1): 120 patients for cobalt chromium bare metal stent.
• Group (2): 120 patients for stainless steel bare metal stent.
Group (1) included 76 (63.33%) males and 44 (36.67%) females with mean age of 53.15± (8.17) years. While group (2) included 74 (61.67%) males and 46 (38.33%) females with mean age of 55.02± (7.86) years. There was no statistically significant difference between the two groups as regard baseline demographic and clinical characteristics (age, sex distribution, hypertension, dyslipidemia, DM, family history of CAD, evidence of CAD, smoking history, ECG changes, and echocardiographic parameters. P > 0.05).
There was no statistically significant difference between both groups as regard Baseline Lesion & Procedural characteristics (number of diseased vessels, the target vessel, percentage of coronary luminal narrowing, lesion length, reference vessel diameter, prior TIMI flow, stent length, stent diameter and dilation pressure). P > 0.05.
During the follow up period device and lesion success was achieved in (100 %) of patients in both groups. while procedural success was achieved in (97.5 %) of patients in cobalt chromium stent group (Two patients suffered acute MI, and one patient suffered cerebrovascular stroke), and achieved in (96.67 %) of patients in stainless steel stent group (Three patients suffered acute myocardial infarction, and one patient suffered cerebrovascular stroke). There was no statistically significant difference between both groups. P > 0.05.
We noticed that, due to the low profile, good elasticity, and push ability; the cobalt chromium stents crossed the tortuous, calcific and complex morphology lesions more easily than stainless steel stents, especially in LCX artery lesions.
The incidence of MACE and TLR increased with the duration of follow-up. At 3-month follow-up, the incidence of MACE was 6.67 % in the cobalt chromium group and 7.5 % in the stainless steel group, P = 0.80 (TLR was 5 % versus 5.83 %. p = 0.78, MI was 3.33 % for both groups, and cardiac death was 1.67% versus 0.83 %. p = 0.56). At 6-month follow-up, the incidence of MACE increased to 21.67 % versus 20.83 %, P = 0.87, (TLR was 19.17 % versus 18.33 %, p = 0.865, MI was 4.17 % versus 5%, p = 0.76 and cardiac death was 1.67% versus 0.83 %, p = 0.56). At 9-month follow-up, the incidence of MACE increased to 24.17 % in cobalt chromium stent group and 25 % in stainless steel stent group, P = 0.88, (TLR was 21.67 % in both groups, MI was 5% versus 6.67 %, p = 0.58, and cardiac death was 1.67% versus 2.5%, p = 0.65). The incidence of clinical ISR increased with the duration of follow-up. At 3-month follow-up, the incidence of clinical ISR was 3.33 % in cobalt chromium stent group and 4.17 % in stainless steel stent group, P = 0.73. At 6-month follow-up, the incidence of clinical ISR increased to 17.5 % in cobalt chromium stent group and 16.67 % in stainless steel stent group, P = 0.86. At 9-month follow-up, the incidence of clinical ISR increased to 20 % in both groups, P = 1.00.
Sub-analysis of data showed that independent risk factors for ISR in our study by multivariate logestic regression were, DM (odds ratio = 1.52, p = 0.044), prior MI (odds ratio = 7.51, p ˂0.0001), prior reduced TIMI flow (odds ratio = 0.31, p = 0.05), longer lesion length (odds ratio = 1.25, p = 0.015), smaller reference vessel diameter (odds ratio = 0.15, p= 0.023), longer stent length (odds ratio = 1.09, p = 0.045), and higher dilation pressure (odds ratio = 1.25, p = 0.038).
Also we found that PCI causes, a highly statistically significant improvement of anginal severity, p < 0.0001, and also there was a highly statistically significant improvement of LVESD, LVEDD, and LVEF, after PCI. P < 0.0001.