Late ST 61 pts (40%)
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-
支架内血栓 In-Stent Thrombosis
ARC 支架内血栓定义
• Definite/Confirmed （肯定的）
– Acute coronary syndrome AND – [Angiographic confirmation of thrombus or occlusion OR – Pathologic confirmation of acute thrombosis]
• Possible （不能排除的）
– Unexplained death after 30 days
支架内血栓的预后
SES (N=13) Death Myocardial Infarction 4 13 BMS (N=15) 5 13
Fatal MI
Q Wave MI Non-Q Wave MI
Stone G et al. NEJM 2007;356:998-1008
SIRTAX – Definite ST @ 4 Years
Pooled Data from RAVEL, SIRIUS, C-SIRIUS, E-SIRIUS
4
8 5
4
5 8
Similar mortality observed for SES and BMS thrombosis
支架内血栓发Biblioteka 时间ST = stent thrombosis; SAT = subacute stent thrombosis; LST = late stent thrombosis; VLST = very late stent thrombosis. Adapted from Bhatt. J Invasive Cardiol. 2003;15(suppl B):3B.
Early period: 0-30 days OR 0.59, 95% CI .35 - 1.01
Late period: 31-180 days OR 0.52, 95% CI .16 – 1.75
Time after PCI >180 days 31-180 days0-30 days
Adjusted Results with interaction terms for time since PCI
5 Cumulative incidence, % 4 3
192 definite ST cases
3.3%
2
Incidence density
1 0 0 1 2 3 3.5 4 Time since PCI in years
1.0 / 100 pt years
Months Cumulative incidence, % Patients at risk
0
0
30
60
120 600 Days
N=1,191
N=1,855
N=361
N=6,058
DES肯定的ST发生率: Bern - Rotterdam Cohort Study
Daemen, Wenaweser et al. Lancet 2007;369:667-78 N=8146
Early ST 91 pts (60%)
支架内血栓与抗凝、抗血小板治疗
Bare Metal Stent
DES
ASA und Anticoagulation
ASA und Ticlopidine ASA und Clopidogrel Prasugrel?
ASA = Acetylsalicylic acid DES: Drug-eluting stent
Favours DES Favours BMS
Favors DES
.1 .2 .5 1 2
Favors BMS
5 10 20 50 100
Very period: 180 days .1 late .2 .5 1 2 5> 10 20 50 100 Odds Ratio OR 9.4,et95% 2.56 – 34.70 Wenaweser al. ACCCI 2007
• Probable （可能的）
– Unexplained death within 30 days – Target vessel MI without angiographic confirmation of thrombosis or other identified culprit lesion
1 1.2 7538
12 1.6 7210
24 2.1 5164
36 2.7 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
Odds Ratio
Very Late ST > 1 Year (Per Protocol)
Sirolimus-Eluting Stent
%
P=0.75
Paclitaxel-Eluting Stent
%
P=0.30
P=0.03 P=0.02
Kastrati A et al. NEJM 2007;356:1030-9
BMS支架内血栓发生率
10 8 N 6 4 2
Wenaweser P et al. EHJ 2005
Early 1.2% (N=71)
Late 0.4% (N=24)
Study population 1995-2002 -6,058 patients undergoing PCI with BMS