高润霖冠心病介入治疗的热点

冠心病介入治 疗 的 热 点 -2008 中国医学科学院阜外心血管病医院 高 润 霖 DES的安全性和 长 期 疗 效 新一代 DES From TCT 2006 From TCT 2006 Time after Initial Procedure (years) 0 1 2 3 4 Time after Initial Procedure (years) TAXUS I, II, IV, V, VI (n=3,513) RAVEL, SIRIUS, E-SIRIUS, and C-SIRIUS (n=1,748) CYPHER stent (n=870) Bare metal stent (n=878) Stone GW et al. NEJM 2007;356:998-1008 0 1 2 3 4 TAXUS stent (n=1,755) Bare metal stent (n=1,758) 9 Prospective, Double-Blind, Randomized Trials Freedom From (Protocol) Stent Thrombosis P=0.2099.4% (5)98.8% (10) P=0.3099.1% (14)98.7% (20) Time after Initial Procedure (years) 0 1 2 3 4 Time after Initial Procedure (years) TAXUS I, II, IV, V, VI (n=3,513) RAVEL, SIRIUS, E-SIRIUS, and C-SIRIUS (n=1,748) CYPHER stent (n=870) Bare metal stent (n=878) Stone GW et al. NEJM 2007;356:998-1008 0 1 2 3 4 TAXUS stent (n=1,755) Bare metal stent (n=1,758) 9 Prospective, Double-Blind, Randomized Trials Freedom From (Protocol) Stent Thrombosis P=0.2099.4% (5)98.8% (10) P=0.3099.1% (14)98.7% (20) 5 vs. 0, P=0.025 After 1 year 9 vs. 2, P=0.028 After 1 year Time after Initial Procedure (years) 0 1 2 3 4 Time after Initial Procedure (years) TAXUS I, II, IV, V, VI (n=3,513) RAVEL, SIRIUS, E-SIRIUS, C-SIRIUS (n=1,748) P=0.2394.7% (45)93.3% (57) CYPHER stent (n=870) Bare metal stent (n=878) Stone GW et al. NEJM 2007;356:998-1008 0 1 2 3 4 P=0.6893.4% (92)93.9% (86) TAXUS stent (n=1,755) Bare metal stent (n=1,758) 9 Prospective, Double-Blind, Randomized Trials Freedom From All Cause Death Time after Initial Procedure (years) 0 1 2 3 4 Time after Initial Procedure (years) TAXUS I, II, IV, V, VI (n=3,513) RAVEL, SIRIUS, E-SIRIUS, C-SIRIUS (n=1,748) P=0.8693.8% (53)93.6% (55) CYPHER stent (n=870) Bare metal stent (n=878) Stone GW et al. NEJM 2007;356:998-1008 0 1 2 3 4 P=0.6693.7% (105)93.0% (115) TAXUS stent (n=1,718) Bare metal stent (n=1,727) 9 Prospective, Double-Blind, Randomized Trials Freedom From Myocardial Infarction Time after Initial Procedure (years) 0 1 2 3 4 Time after Initial Procedure (years) TAXUS I, II, IV, V, VI (n=3,513) RAVEL, SIRIUS, E-SIRIUS, C-SIRIUS (n=1,748) P50% Previous CABG No Yes 50% Baseline characteristics Hazard ratio (95% CI) PCI + OMT compared to OMT resulted in: Significantly less use of nitrates at - 1 year (53% vs. 67%) - 3 years (47% vs. 61%) - 5 years (40% vs. 57%) Significantly less use of Ca+2 channel blockers at - 1 year (40% vs. 49%) - 3 years (43% vs. 50%) - 5 years (42% vs. 52%) Freedom from Anti-anginal Meds During Long-term Follow-up Despite a much higher than anticipated XO to PCI in the OMT group Boden WE et al. NEJM 2007;356:1503-16 Follow-up PCI + OMT OMT P Value Baseline 51 + 25 51 + 25 0.83 3 months 73 + 22 68 + 23 10% (n=62) Shaw LA. AHA 2007 MPS % Ischemic Myocardium Pre-Rx & 6-18 Months 0 40 5 10 15 20 25 35 30 Pre-Rx 6-18m 8.2% 5.5% (4.7%-6.3%) PCI + OMT (n=159) OMT (n=155) 0 40 5 10 15 20 25 35 30 Pre-Rx 6-18m (6.9%-9.4%) 8.6% 8.1% Mean = -2.7% (95% CI = -3.8% to -1.7%) Mean = -0.5% (95% CI = -1.6% to 0.6%) p0.0001 Shaw LA. AHA 2007 Ischemia reduction 5% % with Ischemia Reduction 5% Myocardium p=0.007 PCI + OMT (n=54) OMT (n=51) In 105 pts with moderate-to-severe baseline ischemia Shaw LA. AHA 2007 Death or MI Rate (%) Rates of Death or MI by Ischemia Reduction p=0.001 Ischemia Reduction 5% (n=68) No Ischemia Reduction (n=37) Shaw LA. AHA 2007 In 105 pts with moderate-to-severe baseline ischemia 结论 标 准 药 物治 疗对 改善 稳 定性 CAD预 后有重要价 值 ， 所有 CAD患者不