ami介入治疗时支架选择策略陈纪林 ppt课件.ppt
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1、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 Sessions 2005. Presentation 2303. 4. HAAMU-STENT trial. Available at wwwcardiosourcecom/pops/trialSumasp?trialID=1492. Accessed 5 March 2007. 5.
2、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):1924-30. 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.,20,10,
3、5,Probability of reintervention (%),15,11,12,Months after randomization,10,9,8,7,6,5,4,3,2,1,0,2786 patients,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.,10,P
4、robability of death (%),8,4,6,2,0,HR: 0.76 (95% CI, 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 recurrent myocardial infarction (%),*Trials included were: BASKET; di Lorenzo; HAAMU-STENT; MISSION; PASSION; SE
5、SAMI; STRATEGY; TYPHOON,Kastrati A, et al. Eur Heart J. 2007;28:2706-2713.,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
6、0 (95% CI, 0.46-1.39) p=0.43,Kastrati A, et al. Eur Heart J 2007;28:2706-2713.,Randomisation 1:1,BMS (n=310),Taxus Express2 or Liberte Stent (n=309),STEMI patients with chest pain 20mn and ST-elevation in 2 contiguous leads; infarct related artery with a de novo lesion,Primary Endpoint: Composite of
7、 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.,MACE (%),10,0,120,240,360,5,BMS,Laarman, GJ et al. N Engl J Med. 2006;355:1105-13.,Days,PRIMARY ENDPOINT NOT ACHIEVED HR=0.68 (0.41-1.10) p=0.12,
8、8.7,12.6,No prespecified angiographic F/U,Dual APT recommended for 6 months (Clopidogrel: Median Duration of 9 months),*Cardiac Death, MI, or TLR,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
9、,11.1,5.6,6.0,0,5,10,15,20,MACE,Cardiac Death,TLR,% of Patients,BMS,SES in AMI Typhoon Trial To Assess The Use of the CYPHER Sirolimus-eluting Stent (SES) in Acute Myocardial Infarction Patients Treated With Balloon Angioplasty,Christian Spaulding for the TYPHOON Investigators PCR 2009,SES in AMI Ty
10、phoon 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 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),% 占患者总数的百分比,P 0.00
11、1,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 TLR. TLR: target lesion revascularization. TVR: target vessel revascularization. TVF: target vessel failure defined as ischemia-driven TVR, recurrent MI, or target vessel-related cardia
12、c death MI: myocardial infarction (all). ST: stent thrombosis (per protocol),P = NS,主要终点 TVF,MACE,TLR,TVR,MI,ST,DEATH,HORIZON 2年和TYPHOON 4年结果,A Prospective, Randomized Comparison of Paclitaxel-eluting TAXUS Stents vs. Bare Metal Stents During Primary Angioplasty in Acute Myocardial Infarction Gregg
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