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Hot Topics of Hot Topics of PercutaneousPercutaneous Coronary Intervention 2007Coronary Intervention 2007 Runlin Gao, MD, FACC Cardiovascular Institute and Fu Wai Hospital, Beijing, China Is DES Safe? Late Thrombosis From TCT 2006 Adverse Events (Death 356:998-1008Stone GW et al. NEJM 2007;356:998-1008 0 0 1 1 2 2 3 3 4 4 TAXUS stent (n=1,755) Bare metal stent (n=1,758) 9 Prospective, Double-Blind, Randomized Trials Freedom From (Protocol) Stent Thrombosis P=0.20 99.4% (5) 98.8% (10) P=0.30 99.1% (14) 98.7% (20) Time after Initial Procedure (years)Time after Initial Procedure (years) 0 0 1 1 2 2 3 3 4 4 Time after Initial Procedure (years)Time after Initial Procedure (years) TAXUS I, II, IV, V, VITAXUS I, II, IV, V, VI (n=3,513)(n=3,513) RAVEL, SIRIUS, E-SIRIUS, and C-SIRIUSRAVEL, SIRIUS, E-SIRIUS, and C-SIRIUS (n=1,748)(n=1,748) CYPHER stent (n=870) Bare metal stent (n=878) Stone GW et al. NEJM 2007;356:998-1008Stone GW et al. NEJM 2007;356:998-1008 0 0 1 1 2 2 3 3 4 4 TAXUS stent (n=1,755) Bare metal stent (n=1,758) 9 Prospective, Double-Blind, Randomized Trials Freedom From (Protocol) Stent Thrombosis P=0.20 99.4% (5) 98.8% (10) P=0.30 99.1% (14) 98.7% (20) 5 vs. 0, P=0.025 After 1 yearAfter 1 year 9 vs. 2, P=0.028 After 1 yearAfter 1 year Time after Initial Procedure (years)Time after Initial Procedure (years) 0 0 1 1 2 2 3 3 4 4 Time after Initial Procedure (years)Time after Initial Procedure (years) TAXUS I, II, IV, V, VITAXUS I, II, IV, V, VI (n=3,513)(n=3,513) RAVEL, SIRIUS, E-SIRIUS, C-SIRIUSRAVEL, SIRIUS, E-SIRIUS, C-SIRIUS (n=1,748)(n=1,748) P=0.23 94.7% (45) 93.3% (57) CYPHER stent (n=870) Bare metal stent (n=878) Stone GW et al. NEJM 2007;356:998-1008Stone GW et al. NEJM 2007;356:998-1008 0 0 1 1 2 2 3 3 4 4 P=0.68 93.4% (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)Time after Initial Procedure (years) 0 0 1 1 2 2 3 3 4 4 Time after Initial Procedure (years)Time after Initial Procedure (years) TAXUS I, II, IV, V, VITAXUS I, II, IV, V, VI (n=3,513)(n=3,513) RAVEL, SIRIUS, E-SIRIUS, C-SIRIUSRAVEL, SIRIUS, E-SIRIUS, C-SIRIUS (n=1,748)(n=1,748) P=0.86 93.8% (53) 93.6% (55) CYPHER stent (n=870) Bare metal stent (n=878) Stone GW et al. NEJM 2007;356:998-1008Stone GW et al. NEJM 2007;356:998-1008 0 0 1 1 2 2 3 3 4 4 P=0.66 93.7% (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)Time after Initial Procedure (years) 0 0 1 1 2 2 3 3 4 4 Time after Initial Procedure (years)Time after Initial Procedure (years) TAXUS I, II, IV, V, VITAXUS I, II, IV, V, VI (n=3,513)(n=3,513) RAVEL, SIRIUS, E-SIRIUS, C-SIRIUSRAVEL, SIRIUS, E-SIRIUS, C-SIRIUS (n=1,748)(n=1,748) P DES (n = 5921) BMS (n = 1667)p value Age yrs57.8 10.659.1 11.5 DES (n = 5921) BMS (n = 1667) p value Number of lesions treated1.56 0.771.39 0.6650% Previous CABG No Yes 50% Baseline characteristics Hazard ratio (95% CI) PCI + OMT compared to OMT resulted in:PCI + OMT compared to OMT resulted in: Significantly less use of nitrates at Significantly less use of nitrates at - 1 year (53% vs. 67%)- 1 year (53% vs. 67%) - 3 years (47% vs. 61%)- 3 years (47% vs. 61%) - 5 years (40% vs. 57%)- 5 years (40% vs. 57%) Significantly less use of Ca Significantly less use of Ca+2 +2 channel blockers at channel blockers at - 1 year (40% vs. 49%)- 1 year (40% vs. 49%) - 3 years (43% vs. 50%)- 3 years (43% vs. 50%) - 5 years (42% vs. 52%)- 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 groupDespite a much higher than anticipated XO to PCI in the OMT group BodenBoden WE et al. WE et al. NEJMNEJM 2007;356:1503-16 2007;356:1503-16 Follow-upFollow-upPCI + OMTPCI + OMTOMTOMTP P Value Value BaselineBaseline51 51 + + 25 2551 51 + + 25 250.830.83 3 months3 months73 73 + + 22 2268 68 + + 23 2310% (n=62) Shaw LA. AHA 2007 MPS % Ischemic Myocardium Pre-Rx I2=17% PCI vs. Medical Rx 17 RCTs, 7513 pts Primary End Point: All-Cause Death Kastrati et al; TCT 2007 0.80 (0.64 to 0.99) 0.80 (0.68 to 0.95) 结论结论 标标准的药药物治疗对疗对 改善稳稳定性冠心病的预预后有重 要价值值，所有冠心病病