PCI：适应症和未来发展方向PPT课件.ppt

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1、PCI:Indications&FutureDirectionsS.ChiuWongMD,FACCAssociateProfessorofMedicineWeillMedicalCollegeofCornellUniversityDirector,CardiacCatheterizationLaboratoriesTheNewYorkPresbyterianHospital-CornellCampusACCSymposium:CardiologyUpdate2004GreatWallInternational

2、CongressofCardiologyOctober17,2004BeijingChinaHistoryandCurrentStatusofPCIIndicationsofPercutaneousCoronaryInterventionFutureDevelopmentNovelDrugElutingStentsExpandingBeyondCoronaryVasculatureNewerImagingTechnologiesCellularApproach:AngiogenesisandMyogenesisPCI

3、:Indications&FutureDirectionsSummaryHistoryandCurrentStatusofPCIIndicationsofPercutaneousCoronaryInterventionFutureDevelopmentNovelDrugElutingStentsExpandingBeyondCoronaryVasculatureNewerImagingTechnologiesCellularApproach:AngiogenesisandMyogenesisPCI:Indicatio

4、ns&FutureDirectionsPCI:Indications&FutureDirectionsMilestonesofPTCA1939-1985BalloonAngioplastyNHLBIRegistry1977-81PTCAResultsAngiographicSuccess–88%ProceduralMortality–1%Non-fatalMI–4.3%EmergencyCABG–3.4%NewDeviceAngioplastyHowGoodisBalloonPTCA?(N=458)1985-86(N

5、=140)1992-93(N=500)1991-92(N=202)1991-93(N=1399)1991-92BalloonAngiographicSuccessPCI:Indications&FutureDirectionsRestenosisFollowingPTCAAnAchilles'heelforinterventionalcardiology……PCI:Indications&FutureDirectionsHowGoodisBalloonPTCA?BalloonPTCARestenosisRateI+I

6、ISVG’sNewDeviceAngioplastyTwoMajorGoals1.IncreaseProcedureSuccess2.ReduceRestenosisAngiographicSuccesscomplicationsNewDeviceAngioplastyHowGoodisNewDeviceAngioplasty?AngiographicSuccessOverall(N=2267)Registry(N=215)DCA(N=512)Stent(N=259)PCI:Indications&FutureDir

7、ectionsRestenosisPostStentVs.BalloonRestenosis(%)****P=0.046,**P=0.02NEJM199425%31%U.S.PercutaneousInterventionVolumeTotalPTCAandStentsCases(21%)(37%)(42%)(44%)(70%)(80%)(80%)(80%)(83.4%)ImpactofNewDeviceInterventionsNHLBI1985-1986Vs.DynamicRegistry1997-1998Wil

8、liamsetal,Circ2000;102:2945-2951P<0.001P<0.001P<0.001P<0.001P<0.001ImpactofNewDeviceInterventionsNHLBI1985-1986Vs.DynamicRegistry1997-1998Williamsetal,Circ2000;102:2945-2951