最新复杂的亚组患者中的血运重建术_葛均波(英文版ppt课件.ppt

《最新复杂的亚组患者中的血运重建术_葛均波(英文版ppt课件.ppt》由会员分享，可在线阅读，更多相关《最新复杂的亚组患者中的血运重建术_葛均波(英文版ppt课件.ppt（44页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、复杂的亚组患者中的血运重复杂的亚组患者中的血运重建术建术_葛均波葛均波(英文版）英文版）Revascularization in Complex Patient Subsets The very elderly (C. Grines) Complex CAD and diabetes (V. Fuster) Chronic kidney disease (N. Lepor) Poor LV function (J. Bax) Vascular complications and women (B. Ahmed)Malmberg K, et al. Circulation. 2000;102:1

2、014-1019.Mortality in Patients Assigned to CABG or PCI According to Diabetes Status 10 Trials, 7812 pts, Angiopl 6 Trials & BMS 4 Trials FU 6 yrs MA Hlatky et. al. Lancet 2009;373: March 20thBARI-2 Committee: K. Detre, R. Frye, T. Orchard, D. Kelley, R. Nesto, B. Sobel, S. Genuth, B. ChaitmanCABG (n

3、 = 897)DES (n = 903)All-cause MI Stroke Death/MI/Stroke Revasc MACCE Interv ! CTS ! death% Main Results at 1-Year 2) SYNTAX Trial (TAXUS DES) 3.54.33.24.82.20.67.77.6P = 0.37P = 0.11P = 0.003P = 0.98 P 0.0001P = 0.00155.913.712.117.8Serruys P et al. NEJM 2009;360:961 - SYNTAX high Score Favors CABG

4、PCI Viewpoint: PCI was equal to CABG in hard endpoints of death & MI (even in LM) and Any pt will trade re-PCI (+8%) to CVA Aggressive background therapy for CAD and diabetes20052006200720081408150312981532as of 1/28/092009US: Mount Sinai Medical CenterCanada Vancouver Hosp and Health Sciences Cente

5、rCanada Montreal Heart InstituteSouth America InCor Heart InstituteSouth America Institute Dante Pazzanese TAKE HOME MESSAGECoronary Artery Revascularization in Patients with Chronic Kidney Disease.Norman E. Lepor MD FACCCedars-Sinai Heart InstituteAssociate Clinical Professor of MedicineGeffen Scho

6、ol of Medicine-UCLAWestside Medical Associates of Los AngelesCKD and Revascularization PCI higher risk owing to increased incidence of acute renal injury, restenosis and mortality CAB higher risk for all cause mortality Longer postoperative bleeding times Higher postoperative bleeding rates and tran

7、sfusion requirements Increased length of hospital staysKidney Int. 1999;55:1057-1062.CONTRAST-INDUCED NEPHROPATHY IN-HOSPITAL MORTALITY% IN-HOSPITAL DEATHP BMS) in patients with mild to moderate CKD Surgical revascularization may be best in those with ESRDRevascularization in poor LV functionJeroen

8、J BaxDept CardiologyLeiden University Medical CenterThe NetherlandsACC 2009, OrlandoGrants: GE healthcare, BMS medical imaging, Edwards Lifesciences, Biotronik, St Jude Medical, Boston Scientific, Medtronic Ischemic LV Dysfunction Clinical goal:-identify patients with viable tissue-with potential to

9、 recover function-to justify enhanced surgical riskHow to assess viability? Metabolism (glucose, FFAs): FDG, BMIPP Intact cellmembrane: Tl-201 Intact mitochondria: Tc-99m Intact perfusion: Tl-201, Tc-99m, MCE Contractile reserve: stress echo / MRIConclusions Revascularization in low EF has enhanced

10、risk Assessment of viability is important But also: Scar extent LV size and function Mitral regurgitationSignificantly Improved Vascular Complications Among Women Undergoing PCI:From the Northern New England PCI RegistryBina Ahmed*, Winthrop D. Piper, David Malenka, Peter VerLee, John Robb, Merle Ke

11、llet, Thomas Ryan, Michael Herne, William Phillips and Harold L. Dauerman*University of Vermont College of MedicineVascular Complications Decreasing After PCI:Is This True for Both Women and Men? MethodsVascular Complications Among Women are Linearly Related to AgeVascular Complications in Women Hav

12、e Decreased DramaticallyRevascularization in Complex Patient Subsets The very elderly (C. Grines) Complex CAD and diabetes (V. Fuster) Chronic kidney disease (N. Lepor) Poor LV function (J. Bax) Vascular complications and women (B. Ahmed)Outcomes Following Coronary Stenting in a Linked NCDR and CMS

13、Database: A National Study of Long-Term, Real-World Outcomes of Bare-Metal and Drug-Eluting Stents 650 sites; 262,700 patients 65 years DES 217,675; BMS 45,025. Unadjusted Follow up from Medicare claims data at 3 yearsDESBMSDeath12.917.9Non fatal MI7.310.0Revasc23.424.5We thought so: patients treate

14、d with DES do better.-Slide courtesy of DR HolmesMyocardial Infarction and Ischemia NSTE ACS Integrating new and old therapies Thienopyridines and GP IIb/IIIa inhibition Strategy trials ABOARDImmediate vs. delayed angiography EARLY ACSRoutine early vs. delayed provisional GP IIb/IIIa inhibition-Slide courtesy of LK NewbyMyocardial Infarction and Ischemia New concepts in treatment with proven therapies Statin preloading for PCI ARMYDA-RECAPTURE NAPLES II Plieotropic effects (? Inflammation) The polypill-Slide courtesy of LK Newby44 结束语结束语