药物洗脱支架进展

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1、ConcernsfromDataAnalysisintheReal-WorldShengshouHuM.D.,FACCDepartmentofCardiacSurgeryFuWaiHospital,Beijing,ChinaDES2007UPDATETextbook&TheoryDrug-elutingStentsDrugbasedtherapeuticsBare-metalStentsEvolutionofCardiologyTheEraofDrug-elutingStentsMoreCADp

2、atientspreferDESIpreferalessinvasiveandmorecomfortabletherapy…TheEraofDrug-elutingStentsInthepraiseofDES,controversiesneverstopTheEraofDrug-elutingStentsSafetyandeffectiveness:RemainedunansweredDESvs.BMS:DifferentresultsfromdifferentRCTsDESvs.CABG:3RC

3、TsareongoingEditorialsinNEJMonsafetyandefficacyofDESTheEraofDrug-elutingStentsRestatetheindicationforDESCYPHER:targetlesion≤30mmTAXUS:targetlesion≤28mmTheEraofDrug-elutingStentsWhatisthecurrentstatusofDESinthereal-world?TheEraofDrug-elutingStentsToope

4、rfectdesignedtoconsiderthedifferenceamonghospitals,physiciansEnrolledpatientsarerelativehealthierandexcludepatientsathighriskSelectionbiasanduncontrolled,butcanreflexthetruthinthereal-worldTheEraofDrug-elutingStentsDESinTheReal-worldDESinTheReal-world

5、DESinTheReal-worldDESinTheReal-worldArevolutionbroughtbyDES?DESseemstobeanoptimalchoice*DESreducesrateofstentrestenosiscomparedwithBMS.*HowmuchwillDESbenefitpatientsinthereal-world?*CanDESmaintainitsadvantagecomparedwithbypassinthereal-world?DESinTheR

6、eal-worldDataanalysisfromNewYorkStateRegistryDatabaseDESinTheReal-worldTRIALDESIGNPatientsStatisticalAnalysis17400multi-vesselpatientsDESn=9,963(atleastoneDES)CABGn=7,437Follow-upachievedin99.0%18monthsPropensityAnalysisKaplan-MeiermethodCoxproportion

7、alhazardsmodelsDESinTheReal-worldDES:18-mthrateofrevascularization>30%DESinTheReal-world18-mthSurvivalAnalysisCABGissuperiortoDESintermofTotalMortalityDESinTheReal-world18-mthSurvivalAnalysisforMICABGissuperiortoDESintermofMyocardialInfarctionDESinThe

8、Real-worldSubgroupAnalysisDESinTheReal-worldCABGremainsthestandardofcareforpatientswhorequiremultivesselcoronaryrevascularization.However,stentsmaybeanalternativeforpatientsathighriskforsurgicalcomplicationsorwhenaninformedpatientchoosesalessi