支架内血栓李建平课件.pptVIP

支架内血栓

In-StentThrombosis

北京大学第一医院李建平

ARC支架内血栓定义

支架内血栓的预后SES

(N=13)BMS(N=15)Death45MyocardialInfarction1313FatalMI44QWaveMI85Non-QWaveMI58SimilarmortalityobservedforSESandBMSthrombosisPooledDatafromRAVEL,SIRIUS,C-SIRIUS,E-SIRIUS

支架内血栓发生时间ST=stentthrombosis;SAT=subacutestentthrombosis;LST=latestentthrombosis;VLST=verylatestentthrombosis.AdaptedfromBhatt.JInvasiveCardiol.2003;15(supplB):3B.

StentThrombosis(%)支架内血栓与抗凝、抗血小板治疗ASAundTiclopidineASAundAnticoagulationASAundClopidogrelDESASA=AcetylsalicylicacidDES:Drug-elutingstentBareMetalStentPrasugrel?

01234TimesincePCIinyears012345Cumulativeincidence,%Months112243648Cumulativeincidence,%1.21.62.12.73.3Patientsatrisk75387210516427901051Incidencedensity1.0/100ptyears3.3%3.50.53%(95%CI=0.44-0.64)/year192definiteSTcasesDES肯定的ST发生率:

Bern-RotterdamCohortStudy@4YearsWenaweserPetal.JAmCollCardiol2008,52,1134-

0.52%(95%CI=0.42-0.62)/yearbetween30daysand5yearsDES肯定的支架内血栓发生率:

Bern-CohortStudy@5YearsWenaweserPetal.ESC2008

FavoursDESFavoursBMS180days31-180days0-30daysTimeafterPCI.1.2.5125102050100OddsRatioFavorsDESFavorsBMS.1.2.5125102050100OddsRatioAdjustedResults

withinteractiontermsfortimesincePCIEarlyperiod:0-30daysOR0.59,95%CI.35-1.01Lateperiod:31-180daysOR0.52,95%CI.16–1.75Verylateperiod:180daysOR9.4,95%CI2.56–34.70Wenaweseretal.ACC2007DESvsBMS

Acohortof9,175patientstreatedwitheitherBMSorDES(SESorPES),allpatientswithangiographicallydocumentedSTwereidentifiedascases

EarlyStentThrombosisRR=0.7695%CI=0.30-1.80P=0.55RR=0.8095%CI=0.32-2.03P=0.79Meta-analysisSESvsBMSBavryAetal.AmJCard2005Meta-analysisPESvsBMSStoneGetal.NEJM2007%%

VeryLateST1Year(PerProtocol)P=0.75P=0.02%P=0.30P=0.03%StoneGetal.NEJM2007;356:998-1008KastratiAetal.NEJM2007;356:1030-9Sirolimus-ElutingStentP