药物洗脱支架进展来自真实世界的数据分析

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

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

3、icacyofDESTheEraofDrug-elutingStentsRestatetheindicationforDESCYPHER:targetlesion≤30mmTAXUS:targetlesion≤28mmTheEraofDrug-elutingStentsWhatisthecurrentstatusofDESinthereal-world?TheEraofDrug-elutingStentsTooperfectdesignedtoconsiderthedifferenceamonghospitals,physiciansEn

4、rolledpatientsarerelativehealthierandexcludepatientsathighriskSelectionbiasanduncontrolled,butcanreflexthetruthinthereal-worldTheEraofDrug-elutingStentsDESinTheReal-worldDESinTheReal-worldDESinTheReal-worldDESinTheReal-worldArevolutionbroughtbyDES?DESseemstobeanoptimalcho

5、ice*DESreducesrateofstentrestenosiscomparedwithBMS.*HowmuchwillDESbenefitpatientsinthereal-world?*CanDESmaintainitsadvantagecomparedwithbypassinthereal-world?DESinTheReal-worldDataanalysisfromNewYorkStateRegistryDatabaseDESinTheReal-worldTRIALDESIGNPatientsStatisticalAnal

6、ysis17400multi-vesselpatientsDESn=9,963(atleastoneDES)CABGn=7,437Follow-upachievedin99.0%18monthsPropensityAnalysisKaplan-MeiermethodCoxproportionalhazardsmodelsDESinTheReal-worldDES:18-mthrateofrevascularization>30%DESinTheReal-world18-mthSurvivalAnalysisCABGissuperiorto

7、DESintermofTotalMortalityDESinTheReal-world18-mthSurvivalAnalysisforMICABGissuperiortoDESintermofMyocardialInfarctionDESinTheReal-worldSubgroupAnalysisDESinTheReal-worldCABGremainsthestandardofcareforpatientswhorequiremultivesselcoronaryrevascularization.However,stentsmay

8、beanalternativeforpatientsathighriskforsurgicalcomplicationsorwhenaninformedpatientchoosesalessi