冠心病治疗2008演示文稿.pptVIP

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 based only on anatomy Bioabsorbable stents ? Next PCI breakthrough Thank You 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 Clopidogrel 600mg as early as possible could be helpful Abciximab still needed for high-risk pts Facilitation Upstream GP2b3a Inhibitor no clinical benefit over in lab Full-dose fibrinolytics Harmful Half-dose lytic + GP2b3a Inh Harmful 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 Prof. Yean L. Lim AM Professor Director, Center for Cardiovascular Therapeutics Western Health University of Melbourne Qianjiang PCI Meeting Hangzhou, 1 Aug 2008 CAD Therapy 2008 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) Which Revascularization ? Vessel Lesion Factors (Lesion Complexity) Patient Factors (Diabetes, Renal) Secondary Factors (Costs, Culture) Immediate Risk Long-term Benefit SVD, Suitable Lesion(s) PCI Technically Feasible Inc