复杂的亚组患者中的血运重建术葛均波（英文版）

Revascularization in Complex Patient Subsets: A Report from the ACC.09 and i2 Summit 2009 Modified from Robert A. Harringtons ACC presentation 葛均波 复旦大学中山医院 上海市心血管病研究所 Revascularization in Complex Patient Subsets The very elderly (C. Grines) Complex CAD and diabetes (V. Fuster) Chronic kidney disease (N. Lepor) Poor LV function (J. Bax) Vascular complications and women (B. Ahmed) Revascularization In The Very Elderly Cindy L. Grines, M.D., F.A.C.C. William Beaumont Hospital Royal Oak, Michigan, U.S.A. In-Hospital Complications After PCI: Effect of Age Bachelor, JACC 2000;36:723 Complications* After Elective PCI in Octogenarians Death MI Q-wave Stroke Death/MI/ CVA Renal failure Vascular complications Bachelor. JACC 2000;36:723 * p 60 years old risk of intracranial bleeding Minority receive lytic therapy (10% of patients 65 years old) 80 yrs (n=130) Percent (%) 38% p=.17 36% p=.18 55% p=.0093 p=.72 p=.57 p=.96 Event rate No diabetes/CVD(+) RR = 1.71 (1.41 2.06) No diabetes/CVD() RR = 1.00 Diabetes/CVD(+) RR = 2.85 (2.30 3.53) Diabetes/CVD() RR = 1.71 (1.25 2.33) 3 6 9 12 15 18 21 24 Diabetes + CVD 0.00 0.05 0.10 0.15 0.20 Months No diabetes + CVD Diabetes + no CVD No diabetes + no CVD 3) Risk of Cardiovascular Mortality: OASIS Registry (n = 8,013) Malmberg K, et al. Circulation. 2000;102:1014-1019. Mortality in Patients Assigned to CABG or PCI According to Diabetes Status 10 Trials, 7812 pts, Angiopl 6 Trials 373: March 20th 2) BARI-2D: Evaluating Treatment Options for CAD and DM in Type 2 DM Inclusion Criteria Type 2 DM Stable CAD Exclusion Criteria Mandatory CABG Unstable CAD CAD extent LV function BARI-2 Committee: K. Detre, R. Frye, T. Orchard, D. Kelley, R. Nesto, B. Sobel, S. Genuth, B. Chaitman Revascularization of Choice 262,700 patients 65 years DES 217,675; BMS 45,025. Unadjusted Follow up from Medicare claims data at 3 years DES BMS Death 12.9 17.9 Non fatal MI 7.3 10.0 Revasc 23.4 24.5 We thought so: patients treated with DES do better. -Slide courtesy of DR Holmes Myocardial Infarction and Ischemia NSTE ACS Integrating new and old therapies Thienopyridines and GP IIb/IIIa inhibition Strategy trials ABOARD Immediate vs. delayed angiography EARLY ACS Routine early vs. delayed provisional GP IIb/IIIa inhibition -Slide courtesy of LK Newby Myocardial Infarction and Ischemia New concepts in treatment with proven therapies Stati