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Prof. Yean L. Lim AM Professor 370:937-48. Efficacy of DES Reduced Target Lesion Revascularization Network Analysis HR 0.70 Windecker S, ACC 2008 Chicago PCI for CAD: 2008 Considerations Revascularization therapy for CAD, Who & When ? If Revascularization indicated, PCI or CABG ? If PCI, DES or BMS ? Complex PCI Strategy (STEMI, LM, MVD, Diabetic, Bifurcation CTO) Kastrati ACC 2008 Clopidogrel600mg as early as possible could be helpful Abciximabstill needed for high-risk pts Facilitation Upstream GP2b3a Inhibitorno clinical benefit over in lab Full-dose fibrinolyticsHarmful Half-dose lytic + GP2b3a InhHarmful Primary PCI for STEMI STEMI 介入特点 多取岀 少放入 BMS or DES for Primary PCI for STEMI When to use DES for PPCI Early onset STEMI High risk of restenosis After Thrombo-aspiration After Pre-dilatation UNPROTECTED LEFT MAIN LESION Unprotected LM : PCI or CABG Future of PCI for CAD PCI Milestones: 1977: POBA 1990: BMS 2000: DES 2008: ? Bioabsorbable DES OCT of BVS stent: Normal vessel function after 2 years P. Serruys, Great Minds Symposium, Cairns, July 2008 Conclusion Early PCI for ACS but deferred PCI for Stable Angina, unless large reversible ischemic burden present PCI for all who need revascularization except Diabetics, ULM or when where CABG is contraindicated or unavailable Thrombus aspiration followed by stenting ( ? DES) for Primary PCI for eligible STEMI PCI for CTO should not be ba