PCI . - - PowerPoint PPT Presentation

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PCI . - - PowerPoint PPT Presentation

Mar 26, 2023 237 likes •667 views

PCI . , . , FACP, FACC

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PCI σε ασθενείς με στεφανιαία νόσο πολλών αγγείων. Επιλογή ασθενών, άμεση και απώτερη πρόγνωση.

Σ Χατζημιλτιάδης , FACP, FACC Αναπληρωτής Καθηγητής , Νοσοκομείο ΑΧΕΠΑ , Θεσσαλονίκη

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5‐year survival with balloon angioplasty or stents (PCI) versus coronary artery bypass grafting (CABG) in patients with multivessel disease (MVD).

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Long‐term mortality is similar after CABG and PCI in most patient subgroups with MV coronary artery disease, so choice of treatment should depend on patient preferences for

  • ther outcomes.

CABG compared with PCI for MV disease: a collaborative analysis

  • f individual patient

data from ten randomised trials.

Hlatky M et al, Lancet 2009; 373: 1190–97

CABG might be a better option for patients with diabetes and patients aged 65 years or

  • lder because mortality was found to be lower in these subgroups.
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New York State Registry (Hannan EL et al: NEJM 358:331, 2008)

  • Patients treated with DES or CABG from Oct. 1, 2003 to Dec. 31, 2004
  • Patient exclusions: prior revascularization , LMCA, recent MI
  • Endpoints – death within 30 days/18 months

adjusted adjusted

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Am J Cardiol 2007;99:504–508

e

*

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56 % 61 % 62 % 56 % 40 %

PCI Hachamovitch R,et al. Circulation, 2003;107:2900‐2906 Revascularization compared with Medical Treatment in 10 627 consecutive patients with moderate to large amounts of inducible ischemia

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: 3.6 y f/up after last myocardial perfusion SPECT (MPS) Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial Nuclear Substudy

  • Circulation. 2008;117:1283‐1291.)
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2 year follow‐up

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3/2005 ‐ 4/ 2007

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Reasons for Registry Allocation

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A lesion based scoring system

  • A separate number calculated per lesion
  • Summed to generate the total score
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PCI

(N=903)

CABG

(N=897)

Death/CVA/MI rates were similar between CABG and PCI Death/CVA/MI rates were similar between CABG and PCI Stroke was increased in CABG vs PCI Stroke was increased in CABG vs PCI Repeat revascularization and MACCE were increased in PCI vs CAB Repeat revascularization and MACCE were increased in PCI vs CABG G Non‐inferiority was not met for 12‐month MACCE

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Overall MACCE to 12 months

CABG registry (n=649)

PCI registry (n=198)

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Incidence of Deep Sternal Infection

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Safety of Long Term Use of Clopidogrel : Three Large, Controlled Trials

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In DIABETICS

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? Optimal treatment for patients with both type 2 diabetes mellitus and stable ischemic heart disease

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Randomized Comparison of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Diabetic Patients

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Kapur, A. et al. J Am Coll Cardiol 2010;55:432-440

Forest Plot of Death, Myocardial Infarction, and Stroke in Key Subgroups

1‐Year Results of the CARDia (Coronary Artery Revascularization in Diabetes) Trial

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What is the best treatment option for my patient in 2009?

Incorporate lessons from SYNTAX, COURAGE, FAME, BARI 2D Carefull patient selection Proven ischemia (FAME, COURAGE ) Avoid unnecessary interventions (COURAGE, FAME, BARI 2D) Estimate clinical outcome based on the coronary anatomy (SYNTAX SCORE)?

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