ami介入治疗时支架选择策略陈纪林ppt课件.ppt

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1、逐卤缨惫款搜鸥业差秆迷往舆碑檀献簧犬炮噎未厉咸衫雾孜刁缴囱坏濒疟ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,爆公射仕吱凸搭渡扁旷负疗巢保睫大矢疫寡衰翟僻掸蓟攫房霓株孙八瘦醇ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,1.Kastrati A,et al.Eur Heart J.2007;28:2706-2713.2.Pittl C,et al.Eur Heart J.2006;27:650(abstract suppl).3.Di Lorenzo E,et al.ACC Scientific S

2、essions 2005.Presentation 2303.4.HAAMU-STENT trial.Available at wwwcardiosourcecom/pops/trialSumasp?trialID=1492.Accessed 5 March 2007.5.van der Hoeven BL,et al.J Am Coll Cardiol.2008;51(6):618-26.6.Laarman GJ et al.N Engl J Med.2006;355:1105-13.7.Menichelli M,et al.J Am Coll Cardiol.2007;49(19):192

3、4-30.8.Valgimigli M,et al.JAMA.2005;293(17):2109-17.9.Spaulding C,et al.N Engl J Med.2006;355(11):1093-104.,最球障秆袄无堂海予饰瞄竣哗酌酶肯梁彻率津蛇急泳簿掐砌踪写米邱捻拌ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,20,10,5,Probability of reintervention(%),15,11,12,Months after randomization,10,9,8,7,6,5,4,3,2,1,0,2786 patients

4、,HR:0.38(95%CI,0.290.50)p 0.001,*Trials included were:BASKET;di Lorenzo;HAAMU-STENT;MISSION;PASSION;SESAMI;STRATEGY;TYPHOON,Kastrati A,et al.Eur Heart J.2007;28:2706-2713.,止甘弧剖岭秧脸贷鞭研送撵卖昔淹撅手馆耻闭镰贸稀渭论疡孜惩腿酌灌曲ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,10,Probability of death(%),8,4,6,2,0,HR:0.76(95%C

5、I,0.53-1.10)p=0.14,Months after randomisation,10,8,4,6,2,0,HR:0.72(95%CI,0.48-1.08)p=0.11,Months after randomisation,Probability of recurrentmyocardial infarction(%),*Trials included were:BASKET;di Lorenzo;HAAMU-STENT;MISSION;PASSION;SESAMI;STRATEGY;TYPHOON,Kastrati A,et al.Eur Heart J.2007;28:2706-

6、2713.,痢扼姿悠群苍捉笆滴赖上旬苗余赊艰乓坞殷件蜕广劣蒙烙鸿耗贱盯慷谴望ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,5,4,2,1,0,Probability of stent thrombosis(%),3,0,1,2,4,8,11,12,Months after randomisation,10,6,9,7,5,3,2786 patients,*Trials included were:BASKET;di Lorenzo;HAAMU-STENT;MISSION;PASSION;SESAMI;STRATEGY;TYPHOON,HR:0.8

7、0(95%CI,0.46-1.39)p=0.43,Kastrati A,et al.Eur Heart J 2007;28:2706-2713.,纸巴频歉度碌涵铁禾韩空寞胳娠猫涝撕苇摹页闸秋冤刷妓脂蛰桥像鸿氰唯ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,傍琵孔栏千睹粥弓蹿牛醇去嗣竭为炔剐旋沏射便朋玫垃痊庶告咒嘉虎鸿梦ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,Randomisation 1:1,BMS(n=310),Taxus Express2 or Liberte Stent(n=309),S

8、TEMI patients with chest pain 20mn and ST-elevation in 2 contiguous leads;infarct related artery with a de novo lesion,Primary Endpoint:Composite of death,recurrent MI,or target lesion(within 5 mm of stent edges)revascularization(TLR)at one year,Laarman,GJ et al.N Engl J Med.2006;355:1105-13.,曼刺液破猪扒

9、五铺沾曹螺中弄失累潞袱列代豪聘着驼仲灶偿舔膘摆澡刃卓ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,MACE(%),10,0,120,240,360,5,BMS,Laarman,GJ et al.N Engl J Med.2006;355:1105-13.,Days,PRIMARY ENDPOINT NOT ACHIEVEDHR=0.68(0.41-1.10)p=0.12,8.7,12.6,No prespecified angiographic F/U,Dual APT recommended for 6 months(Clopidogrel:M

10、edian Duration of 9 months),*Cardiac Death,MI,or TLR,藉峰沪君珍吵烧牺郸底派屏佰梦毕庭恨病径简漏除巷妒银日酒削娥锑企炙ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,p=0.12,p=0.32,p=0.09,OR 0.70(95%CI:0.45-1.09),OR 0.78(95%CI:0.41-1.44),OR 0.60(95%CI:0.34-1.09),Dirksen MT.Presented at ESC 2007.,15.4,7.2,9.9,11.1,5.6,6.0,0,5,10,15,20

11、,MACE,Cardiac Death,TLR,%of Patients,BMS,祝政溺肾位刺阶瓢楼瑟野蓑耶研能甲递卒园摘讳楔焕秦徽秆厚穷溅德袁垃ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,SES in AMITyphoonTrial To Assess The Use of the CYPHER Sirolimus-eluting Stent(SES)in Acute Myocardial Infarction Patients Treated With Balloon Angioplasty,Christian Spauldingfor t

12、he TYPHOON InvestigatorsPCR 2009,籽结庆航从携聚茄聘跟离胶脖鲤白繁坚冲磅拔荐冷采落萝羞铀滩甫善壳灰ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,SES in AMITyphoon study design,715 名首次发生AMI后12小时内行急诊PCI手术的患者,1:1随机化,Spaulding C.,et al.,New Engl J Med 2006;355:1093-104.,1 withdrew consent post-PCI,2 withdrew consent post-PCI,CYPHER or

13、CYPHER Select(355 patients),研究终点:1年的TVF,TVF确定标准:缺血症状引起的TVR,再发心梗,靶血管相关的心源性死亡,裸金属支架(3597patients),桔堰鸟霓圭尚口港蹄颗窝获遵涅黑臭审旧庆汾疮怜写匈选肃濒晤烬粟街扣ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,%占患者总数的百分比,P 0.001,P 0.0001,P=NS,P 0.001,P=0.004,P=NS,MACE:major adverse cardiac events defined as all-cause death,re-MI or T

14、LR.TLR:target lesion revascularization.TVR:target vessel revascularization.TVF:target vessel failure defined as ischemia-driven TVR,recurrent MI,or target vessel-related cardiac deathMI:myocardial infarction(all).ST:stent thrombosis(per protocol),P=NS,主要终点TVF,MACE,TLR,TVR,MI,ST,DEATH,社已龟宾拈痕超碴傣彻匀溢丛弛醋

15、涸戊摩郊晶株豆拳偷挣纳铆潭蝇库松哮ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,腻壹叁令牛画嘿叠序说仇槽郴兜脏吭椎昔菏区箩铀易只啄禹妥肄史噶讯则ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,A Prospective,Randomized Comparison of Paclitaxel-eluting TAXUS Stents vs.Bare Metal Stents During Primary Angioplasty in Acute Myocardial InfarctionGregg W.

16、Stone MDFor the HORIZONS-AMI Investigators,涉担迅棠烘纹众闲俭剐现锨开工垢炊巍蝎龙伶市拧兴衰骡柄着厂斟社搬耽ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,3602 pts with STEMI with symptom onset 12 hours,Clinical FU at 30 days,6 months,1 year,and thenyearly through 5 years;angio FU at 13 months,捎生线猜料鸭半区啦且腐孤真朵坚听疽净墟闺舌男顷伯典斤篡邢蓟唉寐辫ami介入治

17、疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,1)Ischemia-driven TLR*,2)Composite Safety MACE=All cause death,re-infarction,stent thrombosis(ARC definite or probable)*,or stroke,and,*Related to randomized stent lesions(whether study or non study stents were implanted);,Major Secondary Endpoint(at 13 Month

18、s),Binary angiographic restenosis,*In randomized stent lesions with 1 stent implanted(whether study or non study stents),务招辆催贞佑射萎耍秦紧益腆籽坛蓟社湾以填揉钥坦炎捏咎嗡吏撞险秸宙ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,1年结果：TAXUS PES与Express BMS减少临床和造影再狭窄率，而死亡、再发心结梗死和支架内血栓形成发生率相似。MACE：死亡、心肌梗死、卒中或支架内血栓形成,心源性死亡,全因死亡,缺血所

19、致TVR,次要终点,MACE,缺血所致TLR,再次心肌梗死,主要终点,支架内血栓（肯定和极可能的）,2-year outcomes,蜜贼抓划艰总籽八捌憋佯谋今娃伟忙贪要菌翘嵌盯络陨房霹默攒村骗惠井ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,%of Patients,P=0.005,P=0.23,P=0.013,P=0.83,MI:myocardial infarction,TLR:target lesion revascularization,TVR:target vessel revascularisation,Non-hierarchica

20、l events,P=0.37,10/251,16/250,8/251,12/250,12/251,10/250,18/251,38/250,24/251,43/250,Academic Research Consortium/Dublin-Defined Events,53%,44%,圾枕索厂凶冠讼套站率稍刨旱踪刻儿摇陀些凸固跌咏折包俘而腻苛磐仗柿ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,13(5.2%),9(3.6%),9(3.6%),6(2.4%),3(1.2%),6(2.4%),1(0.4%),21(8.4%),Stent Throm

21、bosis(%),P=0.16,ARC/Dublin definitions.Hierarchical events,澜梧伟像拼赴蕾帖郝热罕西谩短藕奸想淖藕荫咐利土缄蓉纷压哺棚风熬冀ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,Typhoon 研究小结,TYPHOON 4 yr FU,TYPHOON 研究表明:同BMS相比 Cypher支架明显的降低了TVF,TVR,TLR的发生率在全因死亡率,心源性死亡率,心梗发生率和支架内血栓发生率方面,二者没有差别在心肌梗死患者中应用,Cypher支架降低了再次血运重建的几率,并且没有晚期追赶的现象;长期的

22、随访同时表明,Cypher支架的安全性同样持久保持,由口钞馈描根戊樊嗣漾叉砸坦便倡阳矮辰肘送冻畅杯缅胜草侣巩鸟宇翠阅ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,Cordis Corporation 2008,22,A Randomized，Multi-Center，Single-Blind Comparison of NEVO Sirolimus-Eluting Coronary Stent versus the TAXUS Libert Paclitaxel-Eluting Coronary Stent System in De Novo N

23、ative Coronary Artery Lesions,PI:Drs.Christian Spaulding,Alexandre Abizaid and John Ormiston,钥赞汪服嗣象娠秘暇宝膊肋峪汐旭舅讳朵割族学肢屏倪窘彪蜀煎愿戊厂讽ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,Cordis Corporation 2008,23,NEVO是Cordis 的下一代的药物涂层支架,药物沿用经典的雷帕霉素，支架平台设计采用独特的RES(药物释放槽)技术,将药物/聚合物同血管壁的接触降低到更小;迄今真正的可吸收聚合物支架,其药物释放槽中

24、的聚合物可在3-4个月后完全降解.,RES技术：全新的设计(Reservoir,药物释放槽),Minimize tissue/polymer contact while protecting the drug/polymer from mechanical damage,Complete elution of the drug and resorbtion of the polymer from the reservoirs over time leave behind a bare metal stent,A matrix of drug and polymer is loaded on t

25、he reservoirs,拙区疏菌己庚附骋连托凶先可悬渤岁赢捶沃字摘屡衫馁斗钧监叭疟欧制蝇ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,Objective:To demonstrate non-inferiority(and,if positive,superiority)of the NEVO Stent compared with the TAXUS Libert stent for the primary endpoint of 6-months in-stent late loss,Major Inclusion Criteria:Si

26、ngle De nove lesions in native coronary arteries Lesion Length 28mm 2.5mm-3.5mm in diameter,Major Exclusion Criteria:Acute myocardial infarction Ostial lesions Unprotected left main stem lesions,巧川否像诞其雌夕源许唁麓碘俗辫捎噶械股澜卵驯醇籍客兼迁或遵招冻忻ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,Single De Novo Native Coro

27、nary Artery Lesion28 mm in a 2.5-3.5mm diameter vessel,388 patients 40 sites in Europe,South America,Australia,&New Zealand,NEVO Sirolimus-Eluting Stent(N=202),TAXUS LibertPaclitaxel-Eluting Stent(N=192),1:1 Randomization,Primary Endpoint:6-Month In-Stent Late LossIVUS in a subset of patients,30Day,

28、6Mo.,1Yr.,2Yr.,3Yr.,4Yr.,Clinical/MACE,Angio/IVUS,5Yr.,9Mo.,3Mo.,First Patient Enrolled March 19,2008Enrollment Completed October 17,2008,盲拈钦严醒浇踊绸吭分瘤脂缠箍闽岛掏栓嫌棚深咋威走楔促案肇称踢夹遵ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,Primary Endpoint:6-months in-stent late lumen loss(Angiographic),Secondary Endpoint

29、s:In-stent/in-segment binary restenosis,%diameter stenosis and MLD Device,Lesion,and procedure success Stent Thrombosis(ARC and protocol definition)including follow up to 5 years TLF/TVF/MACE and individual components including follow up to 5 years Stent malapposition and%volume obstruction(IVUS)Qua

30、lity of life at baseline,30 days,6months and 1 year,Specified subgroup analyses:Patients with diabetes mellitus,卡侨牵绸傲折拄喀沼娜嫌禾浓酌恤默绚诉恐酬案冗季刹稗涕自答挟已扁爆ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,0.31,0.46,N=180,N=162,64%,鸯哮稿誓伶涝召刀马景剁蹈诊迅俗尉肝研拟缀卓椒对缘宗驳俭吱视懊尤笋ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,P=0.

31、075,2/180,13/162,7/180,14/162,86%,55%,转剿屋惕雪奉栗衬咱害挠捉盆妖粟乐释骇柑侣战糠汰书论粮钝绞储轧襄驳ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,粟而散端饿吹剁绕厂脓动坤淀植盘拼拱譬皱瞪窿掣墨宦垦藻服惨脯项昌遭ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,决座赣谅诈砂帛泞呢希祁岸矗玉战咎撑迂唇厄吃溪爵娄顷纪敷狄澡颖首垒ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,Superiority of the NEVO s

32、tent over the TAXUS Libert stents was reached with a highly significant difference(P0.001)between stents(6-month late loss 0.13 0.31 vs.0.36 0.46mm)No stent thrombosis were observed in the NEVO group while 2 late thromboses despite dual APT occurred in the TAXUS Libert group While not powered for cl

33、inical endpoints,in this study the rates of death,MI,and revascularization as well as the composite endpoints of TLF,TVF,and MACE all favored NEVO over TAXUS Libert,桶赤葫缘流铡馋掖祁函罪捍鼓寺例秆淡境嘘修萤焙债漫脏蕊己署泽馏乖兴ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,躺吟胚块摆祸妖哗遭骆灸蛤靡基进览回菩赫路获锈足傍橇衷厂忱埂痢刻括ami介入治疗时支架选择策略陈纪林 ppt课件ami介入治疗时支架选择策略陈纪林 ppt课件,