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Choice of stent for AMI patients The University of Tokyo Hospital - - PowerPoint PPT Presentation
Choice of stent for AMI patients The University of Tokyo Hospital - - PowerPoint PPT Presentation
Choice of stent for AMI patients The University of Tokyo Hospital Jiro Ando, MD Which Stent we can use in AMI BMS or DES ? Drug-Eluting Stents The Concept Stent design and delivery system Drug- Pharmacologic Drug carrier Eluting vehicle
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BMS or DES ?
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The Concept
Stent design and delivery system Pharmacologic agent
Drug- Eluting Stent
Drug-Eluting Stents
Drug carrier vehicle
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The Cypher Sirolimus-Eluting Stent
Bx VELOCITYTMStent
- Balloon expandable stainless
steel stent
- Blend of components:
2 polymers (PEVA + PBMA) and sirolimus in a fixed ratio
- Thin uniform coating
(~ 10um thick)
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0% 5% 10% 15% 20% 25% 30% 365 730 1095 1460 1825
Bare Metal Stent (n=870) CYPHER Stent (n=878) p<0.0001 9.6% (80) 23.9% (205) Days
Number at risk
BMS CYPHER 870 877 680 827 659 797 632 766 603 732 518 645
RAVEL, SIRIUS, E-SIRIUS, C-SIRIUS
Kirtane A. TCT 2007. Adapted from Stone GW et al. NEJM 2007;356:998–1008
CYPHER vs. BMS: TLR
Pooled Analyses of 4 RCTs
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0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 365 730 1095 1460 1825
Bare Metal Stent (n=870) CYPHER Stent (n=878) p=0.99 2.1% (17) 2.0% (17) Days
Number at risk
BMS CYPHER 870 878 848 858 834 835 813 809 784 783 683 694
RAVEL, SIRIUS, E-SIRIUS, C-SIRIUS
Pooled Analyses of 4 RCTs
CYPHER vs. BMS: ARC def/prob ST*
* ARC def/prob ST counts all ST
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Vascular responses in porcine
models
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BMS or DES ?
- BMS Stented region is good Covered with
neointima , and we can reduce DAPT in early term .
- First generation DES stented region isn’t
covered well with neointima , and we continue DAPT in long term.
- But BMS result of restenosis rate is higher
than DES.
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How about Second generarion DES in ACS and DAPT ?
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Everolimus-eluting stent vs. Bare-metal stent in ST-segment elevation myocardial infarction
EXAMINATION randomized trial
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2-year results of the EXAMINATION randomized trial
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2-year results of the EXAMINATION randomized trial
― Stent Thrombosis ―
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The COMFORTABLE AMI Randomized Trial
To compare stents eluting biolimus from a biodegradable polymer with bare-metal stents in primary PCI.
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2-year results of the Conformatble AMI
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Demonstrate the safety and efficacy of the Ultimaster by comparing with Xience
CENTURY II Trial
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CENTURY II Trial
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CENTURY II – High risk ACS
Total population
n=1119
BP-SES
n= 126 patients/ 166 lesions
PP-EES
n= 138 patients 205 lesions
Acute Coronary Syndrome
n=264 BP-SES n=562 PP-EES n=557 Randomization 1:1
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Clinical outcomes at 12 months
0.0159 0.0159 0.0317 0.0317 0.0476 0.0476 0.0145 0.0362 0.0362 0.0217 0.0435 0.0507 0.0725 Cardiac death MI Target vessel MI CD TLR CD TVR TLF TVF 0% 1% 2% 3% 4% 5% 6% 7% 8% Ultimaster Xience
P=NS P=NS P=NS P=NS P=NS P=NS P=NS
TVF: composite of cardiac death, target vessel MI and clinically driven TVR TLF = composite of cardiac death, target vessel MI and clinically driven TLR
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Conclusions
- 2nd generation DES is good result for ACS ,and
also the risk of thrombotic occulusion is low.
- Many of New generation DES will be