OR=2.4 (1.1-5.6)
Odds Ratio
Ong et al Iakovou et al Kuchulakanti et al Roy et al JACC 2005* JAMA 2005 Circulation 2006 J Interv Card 2007
*in setting of AMI
• Possible （不能排除的）
– Unexplained death after 30 days
支架内血栓的预后
SES BMS (N=13) (N=15)
Death
4
5
Myocardial Infarction
13
13
Fatal MI
4
4
Q Wave MI
8
5
Non-Q Wave MI
5
8
Similar mortality observed for SES and BMS thrombosis
Park et al Machecourt et al De la Torre et al Airoldi et al
JAMA 2005 Am J Card 2006 JACC 2007
JACC 2008 Circulation 2007
支架内血栓的预测因素-分叉病变
OR=12.9 OR=6.4 OR=4.4 (4.7-35.8) (2.9-14.1) (2.0-10.0)
Minimal Stent CSA
mm2 P<0.001
Stent Expansion
Residual Stenosis
% P<0.001
P<0.001
支架内血栓预测因素 药物反应异常
Wenaweser P et al. JACC 2005; 45(11):1748-52
服药后血小板活性与DES ST的关系
Biondi-Zoccai G et al. EHJ 2006
% P=0.01
P=0.01
N=2,894
N=2,418
早期支架内血栓IVUS预测因素
With the Use of Sirolimus-Eluting Stents
Fujii K et al. J Am Coll Cardiol 2005;45:995-8
Wenaweser P et al. ESC 2008
支架内血栓的预测因素-支架长度
OR=1.03 OR=1.02
OR=1.01 OR=1.08
(1.00-1.05) (1.00-1.04) (1.00-1.03) (1.06-1.1)
OR=2.75 (1.55-4.88)
Odds Ratio
Iakovou et al
0.20
0.15
0.10
4-year HR 3-year HR 1.06 [0.57, 1.95]
2-year HR 0.90 [0.47, 1.73] P = 0.86
1-year HR 0.86 [0.40, 1.87] P = 0.75
0.05
1.12 [0.46, 2.76] P = 0.01
OWeRnaw9es.4er,et9aO5l.dA%dCsCRC2a0I0ti72o .56 – 34.70
Odds Ratio
Very Late ST > 1 Year (Per Protocol)
Sirolimus-Eluting Stent
% P=0.75
Paclitaxel-Eluting Stent
BMS支架内血栓发生率
10 Early Late Study population 1995-2002
8
1.2% 0.4% -6,058 patients undergoing (N=71) (N=24) PCI with BMS
6 N
4
Wenaweser P et al. EHJ 2005
2
00
Late period: 31-180 days OR 0.52, 95% CI .16 – 1.75
Favours DES Favours BMS
Favors DES Favors BMS
Very.1 la.2te.5pe1rio2 d:5 >1018200 5d0a1y00s .1 .2 .5 1 2 5 10 20 50 100
Iakovou et al JAMA 2005
Park et al Am J Card 2006
Kuchulakanti et al Circulation 2006
Airoldi et al Circulation 2007
支架内血栓发生时的抗血小板治疗
Bern-Rotterdam Cohort Study @ 5 Years
%
P=0.30
P=0.02
P=0.03
Kastrati A et al. NEJM 2007;356:1030-9
Stone G et al. NEJM 2007;356:998-1008
SIRTAX – Definite ST @ 4 Years
Windecker S et al ESC 2008
4
3.3%
3
Cumulative incidence, %
2
Incidence density
1
1.0 / 100 pt years
0
0
1
2
3 3.5 4
Time since PCI in years
Months
1
12 24 36
Cumulative incidence, % 1.2 1.6 2.1 2.7
Time after PCI >180 days 31-180 days0-30 days
Adjusted Results with interaction terms for time since PCI
Early period: 0-30 days OR 0.59, 95% CI .35 - 1.01
Treatement
STENT THROMBOSIS
Intervention
Residual Dissection Incomplete Stent Apposition Antithromobotic Medication
Vessel Reaction
Vessel Remodeling Hypersensitivity Reaction
Buonamici P et al JACC 2007
p<0.001
p=ns
p<0.001
p<0.001
过早停用抗血小板药物是支架内血栓的重要 预测因素
OR=89.8 (29.9-270)
HR=19.2 (5.6-65.5)
OR=4.8 (2.0-11.1)
HR=13.7 (4.0-46.7)
Odds/Hazard Ratio
Urban et al Circulation 2006
De la Torre et al JACC 2008
Impact of Thrombus Burden on Risk of ST
With DES in Patients With STEMI
Sianos G et al. J Am Coll Cardiol 2007;50:573-83
Joner et al JACC 2006
支架内血栓的预测因素-ACS
Hale Waihona Puke OR=12.4 OR=2.3 (1.7-89.7) (1.3-4.0)
OR=1.8 (1.1-2.7)
HR=2.6 (1.3-4.9)
Odds/Hazard Ratio
Park et al Am J Card 2006
Daemen et al Lancet 2007
Patients at risk
7538 7210 5164 2790
48 3.3 1051
DES肯定的支架内血栓发生率: Bern-Cohort Study @ 5 Years
Wenaweser P et al. ESC 2008
DES vs BMS
A cohort of 9,175 patients treated with either BMS or DES (SES or PES), all patients with angiographically documented ST were identified as cases
Delayed Healing
Lesion
Vessel Size Thrombus
早期支架内血栓的预测因素: 残留夹层/撕裂
Bare Metal Stents
MACE @ 30 days
Schühlen H et al. Circulation 1998
Drug-Eluting Stents
MACE @ 30 days
支架内血栓与抗凝、抗血小板治疗
Bare Metal Stent
ASA und Anticoagulation ASA und Ticlopidine
DES
ASA und Clopidogrel Prasugrel?
ASA = Acetylsalicylic acid DES: Drug-eluting stent
Incidence density: 1.3 / 100 patient years
DES肯定的ST发生率:
Bern-Rotterdam Cohort Study @ 4 Years
Wenaweser P et al. J Am Coll Cardiol 2008, 52, 1134-