资源描述：
《支架内血栓-李建平》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。
1、支架内血栓In-StentThrombosis北京大学第一医院李建平Definite/Confirmed（肯定的）AcutecoronarysyndromeAND[AngiographicconfirmationofthrombusorocclusionORPathologicconfirmationofacutethrombosis]Probable（可能的）Unexplaineddeathwithin30daysTargetvesselMIwithoutangiographicconfirmationofthromb
2、osisorotheridentifiedculpritlesionPossible（不能排除的）Unexplaineddeathafter30daysARC支架内血栓定义支架内血栓的预后SES (N=13)BMS(N=15)Death45MyocardialInfarction1313FatalMI44QWaveMI85Non-QWaveMI58SimilarmortalityobservedforSESandBMSthrombosisPooledDatafromRAVEL,SIRIUS,C-SIRIUS,E-SIRI
3、US支架内血栓发生时间ST=stentthrombosis;SAT=subacutestentthrombosis;LST=latestentthrombosis;VLST=verylatestentthrombosis.AdaptedfromBhatt.JInvasiveCardiol.2003;15(supplB):3B.StentThrombosis(%)支架内血栓与抗凝、抗血小板治疗ASAundTiclopidineASAundAnticoagulationASAundClopidogrelDESASA=Acet
4、ylsalicylicacidDES:Drug-elutingstentBareMetalStentPrasugrel?BMS支架内血栓发生率Days108642003060120600NEarly1.2%(N=71)Late0.4%(N=24)Studypopulation1995-2002-6,058patientsundergoingPCIwithBMSWenaweserPetal.EHJ2005N=1,191N=1,855N=361N=6,058StentThrombosis(%)DES肯定的ST发生率: Ber
5、n-RotterdamCohortStudyDaemen,Wenaweseretal.Lancet2007;369:667-780.6%/yearEarlyST91pts(60%)LateST61pts(40%)Incidencedensity:1.3/100patientyearsN=814601234TimesincePCIinyears012345Cumulativeincidence,%Months112243648Cumulativeincidence,%1.21.62.12.73.3Patientsatris
6、k75387210516427901051Incidencedensity1.0/100ptyears3.3%3.50.53%(95%CI=0.44-0.64)/year192definiteSTcasesDES肯定的ST发生率: Bern-RotterdamCohortStudy@4YearsWenaweserPetal.JAmCollCardiol2008,52,1134-0.52%(95%CI=0.42-0.62)/yearbetween30daysand5yearsDES肯定的支架内血栓发生率: Bern-Coh
7、ortStudy@5YearsWenaweserPetal.ESC2008FavoursDESFavoursBMS>180days31-180days0-30daysTimeafterPCI.1.2.5125102050100OddsRatioFavorsDESFavorsBMS.1.2.5125102050100OddsRatioAdjustedResults withinteractiontermsfortimesincePCIEarlyperiod:0-30daysOR0.59,95%CI.35-1.01Latep
8、eriod:31-180daysOR0.52,95%CI.16–1.75Verylateperiod:>180daysOR9.4,95%CI2.56–34.70Wenaweseretal.ACC2007DESvsBMSAcohortof9,175patientstreatedwitheitherBMSorDES(SE
