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1、2020 6 9 1 2020 6 9 2 1 KastratiA etal EurHeartJ 2007 28 2706 2713 2 PittlC etal EurHeartJ 2006 27 650 abstractsuppl 3 DiLorenzoE etal ACCScientificSessions2005 Presentation2303 4 HAAMU STENTtrial Availableatwwwcardiosourcecom pops trialSumasp trialID 1492 Accessed5March2007 5 vanderHoevenBL etal JA
2、mCollCardiol 2008 51 6 618 26 6 LaarmanGJetal NEnglJMed 2006 355 1105 13 7 MenichelliM etal JAmCollCardiol 2007 49 19 1924 30 8 ValgimigliM etal JAMA 2005 293 17 2109 17 9 SpauldingC etal NEnglJMed 2006 355 11 1093 104 2020 6 9 3 20 10 5 Probabilityofreintervention 15 11 12 Monthsafterrandomization
3、10 9 8 7 6 5 4 3 2 1 0 2786patients HR 0 38 95 CI 0 29 0 50 p 0 001 Trialsincludedwere BASKET diLorenzo HAAMU STENT MISSION PASSION SESAMI STRATEGY TYPHOON KastratiA etal EurHeartJ 2007 28 2706 2713 2020 6 9 4 10 Probabilityofdeath 8 4 6 2 0 HR 0 76 95 CI 0 53 1 10 p 0 14 Monthsafterrandomisation 10
4、 8 4 6 2 0 HR 0 72 95 CI 0 48 1 08 p 0 11 Monthsafterrandomisation Probabilityofrecurrentmyocardialinfarction Trialsincludedwere BASKET diLorenzo HAAMU STENT MISSION PASSION SESAMI STRATEGY TYPHOON KastratiA etal EurHeartJ 2007 28 2706 2713 2020 6 9 5 5 4 2 1 0 Probabilityofstentthrombosis 3 0 1 2 4
5、 8 11 12 Monthsafterrandomisation 10 6 9 7 5 3 2786patients Trialsincludedwere BASKET diLorenzo HAAMU STENT MISSION PASSION SESAMI STRATEGY TYPHOON HR 0 80 95 CI 0 46 1 39 p 0 43 KastratiA etal EurHeartJ2007 28 2706 2713 2020 6 9 6 2020 6 9 7 Randomisation1 1 BMS n 310 TaxusExpress2orLiberteStent n
6、309 STEMIpatientswithchestpain 20mnandST elevationin 2contiguousleads infarctrelatedarterywithadenovolesion PrimaryEndpoint Compositeofdeath recurrentMI ortargetlesion within5mmofstentedges revascularization TLR atoneyear Laarman GJetal NEnglJMed 2006 355 1105 13 2020 6 9 8 MACE 10 0 120 240 360 5 B
7、MS Laarman GJetal NEnglJMed 2006 355 1105 13 Days PRIMARYENDPOINTNOTACHIEVEDHR 0 68 0 41 1 10 p 0 12 8 7 12 6 NoprespecifiedangiographicF U DualAPTrecommendedfor 6months Clopidogrel MedianDurationof9months CardiacDeath MI orTLR 2020 6 9 9 p 0 12 p 0 32 p 0 09 OR0 70 95 CI 0 45 1 09 OR0 78 95 CI 0 41
8、 1 44 OR0 60 95 CI 0 34 1 09 DirksenMT PresentedatESC2007 15 4 7 2 9 9 11 1 5 6 6 0 0 5 10 15 20 MACE CardiacDeath TLR ofPatients BMS 2020 6 9 10 SESinAMITyphoonTrialToAssessTheUseoftheCYPHER Sirolimus elutingStent SES inAcuteMyocardialInfarctionPatientsTreatedWithBalloonAngioplasty ChristianSpauldi
9、ngfortheTYPHOONInvestigatorsPCR2009 2020 6 9 11 SESinAMITyphoonstudydesign 715名首次发生AMI后12小时内行急诊PCI手术的患者 1 1随机化 SpauldingC etal NewEnglJMed2006 355 1093 104 1withdrewconsentpost PCI 2withdrewconsentpost PCI CYPHER orCYPHERSelect 355patients 研究终点 1年的TVF TVF确定标准 缺血症状引起的TVR 再发心梗 靶血管相关的心源性死亡 裸金属支架 3597pa
10、tients 2020 6 9 12 占患者总数的百分比 P 0 001 P 0 0001 P NS P 0 001 P 0 004 P NS MACE majoradversecardiaceventsdefinedasall causedeath re MIorTLR TLR targetlesionrevascularization TVR targetvesselrevascularization TVF targetvesselfailuredefinedasischemia drivenTVR recurrentMI ortargetvessel relatedcardiacdea
11、thMI myocardialinfarction all ST stentthrombosis perprotocol P NS 主要终点TVF MACE TLR TVR MI ST DEATH 2020 6 9 13 HORIZON2年和TYPHOON4年结果 2020 6 9 14 AProspective RandomizedComparisonofPaclitaxel elutingTAXUSStentsvs BareMetalStentsDuringPrimaryAngioplastyinAcuteMyocardialInfarctionGreggW StoneMDFortheHO
12、RIZONS AMIInvestigators 2020 6 9 15 3602ptswithSTEMIwithsymptomonset 12hours ClinicalFUat30days 6months 1year andthenyearlythrough5years angioFUat13months 2020 6 9 16 1 Ischemia drivenTLR 2 CompositeSafetyMACE Allcausedeath re infarction stentthrombosis ARCdefiniteorprobable orstroke and Relatedtora
13、ndomizedstentlesions whetherstudyornonstudystentswereimplanted MajorSecondaryEndpoint at13Months Binaryangiographicrestenosis Inrandomizedstentlesionswith 1stentimplanted whetherstudyornonstudystents 2020 6 9 17 1年结果 TAXUSPES与ExpressBMS减少临床和造影再狭窄率 而死亡 再发心结梗死和支架内血栓形成发生率相似 MACE 死亡 心肌梗死 卒中或支架内血栓形成 心源性死
14、亡 全因死亡 缺血所致TVR 次要终点 MACE 缺血所致TLR 再次心肌梗死 主要终点 支架内血栓 肯定和极可能的 2 yearoutcomes 2020 6 9 18 ofPatients P 0 005 P 0 23 P 0 013 P 0 83 MI myocardialinfarction TLR targetlesionrevascularization TVR targetvesselrevascularisation Non hierarchicalevents P 0 37 10 251 16 250 8 251 12 250 12 251 10 250 18 251 38
15、250 24 251 43 250 AcademicResearchConsortium Dublin DefinedEvents 53 44 2020 6 9 19 13 5 2 9 3 6 9 3 6 6 2 4 3 1 2 6 2 4 1 0 4 21 8 4 StentThrombosis P 0 16 ARC Dublindefinitions Hierarchicalevents 2020 6 9 20 Typhoon研究小结 TYPHOON4yrFU TYPHOON研究表明 同BMS相比Cypher支架明显的降低了TVF TVR TLR的发生率在全因死亡率 心源性死亡率 心梗发生
16、率和支架内血栓发生率方面 二者没有差别在心肌梗死患者中应用 Cypher支架降低了再次血运重建的几率 并且没有晚期追赶的现象 长期的随访同时表明 Cypher支架的安全性同样持久保持 2020 6 9 21 22 ARandomized Multi Center Single BlindComparisonofNEVO Sirolimus ElutingCoronaryStentversustheTAXUS Libert Paclitaxel ElutingCoronaryStentSysteminDeNovoNativeCoronaryArteryLesions PI Drs ChristianSpaulding AlexandreAbizaidandJohnOrmiston 2020 6 9 23 NEVO是Cordis的下一代的药物涂层支架 药物沿用经典的雷帕霉素 支架平台设计采用独特的RES 药物释放槽 技术 将药物 聚合物同血管壁的接触降低到更小 迄今真正的可吸收聚合物支架 其药物释放槽中的聚合物可在3 4个月后完全降解 RES技术 全新的设计 Reservoir 药物释放槽
