Can thiệp cấp cứu động mạch vành: Lựa chọn stent trần hay stent phủ thuốc - Nguyễn Cửu Lợi

Can thiệp cấp cứu động mạch vành: 
lựa chọn stent trần hay stent phủ thuốc 
------------------ 
TS. Nguyễn Cửu Lợi 
Trung tâm Tim mạch – Bệnh viện Trung Ương Huế 
Maarten A. Vink, Maurits T. Dirksen, Maarten J. Suttorp, Jan G.P. Tijssen, Jeroen van Etten, 
Mark S. Patterson, Ton Slagboom, Ferdinand Kiemeneij, Gerrit J. Laarman. 
• Randomly assigned 619 patients presenting with STEMI to a 
paclitaxel-eluting stent (PES) or the similar BMS. 
• The primary end point was the composite of cardiac death, 
recurrent myocardial infarction, or TLR. 
• Follow-up at 5 years. 
Paclitaxel-Eluting Versus Conventional Stent in Myocardial 
Infarction with ST-Segment Elevation [PASSION] 
Conclusions 
In the present analysis of PES compared with BMS in primary 
percutaneous coronary intervention for STEMI: 
- No significant difference in major adverse cardiac events 
was observed. 
- In addition, no difference in the incidence of definite or 
probable ST was seen, although very late ST was almost 
exclusively seen after the use of PES. 
J Am Coll Cardiol Intv 2011;4:24–9 
Paclitaxel-Eluting Versus Conventional Stent in Myocardial Infarction 
with ST-Segment Elevation [PASSION] 
Ev
en
ts
 %
- 3980 (63.2%) DES (99% PES & SES) 
- 2318 (36.8%) BMS 
Bindu Kalesan, Thomas Pilgrim, Katja Heinimann, Lorenz Räber, Giulio G. Stefanini, Marco Valgimigli, 
Bruno R. da Costa, François Mach, Thomas F. Lüscher, Bernhard Meier, Stephan Windecker, Peter Jüni 
Comparison of drug-eluting stents with bare metal stents in 
patients with ST-segment elevation myocardial infarction 
(15 RCT) 
2012 Apr;33(8):977-87 
Comparison of drug-eluting stents with bare metal stents in patients with ST-segment 
elevation myocardial infarction (cont’) 
Overall 
Year 1 
Subsequent year 
Comparison of drug-eluting stents with bare metal stents in patients with ST-segment 
elevation myocardial infarction (cont’) 
Overall 
Year 1 
Subsequent year 
Comparison of drug-eluting stents with bare metal stents in patients with ST-segment 
elevation myocardial infarction (cont’) 
Bindu Kalesan, Thomas Pilgrim, Katja Heinimann, Lorenz Räber, Giulio G. Stefanini, Marco Valgimigli, 
Bruno R. da Costa, François Mach, Thomas F. Lüscher, Bernhard Meier, Stephan Windecker, Peter Jüni 
CONCLUSION 
An early benefit of early generation DES in primary 
PCI for STEMI with a reduction in TVR and a trend 
towards less definite ST is offset in subsequent years 
by an increased risk of very late ST. 
Comparison of drug-eluting stents with bare metal stents in patients with ST-segment 
elevation myocardial infarction (cont’) 
Paclitaxel-Eluting Stents versus Bare-Metal Stents 
in Acute Myocardial Infarction 
Gregg W. Stone, M.D., Alexandra J. Lansky, M.D., Stuart J. Pocock, Ph.D., 
Bernard J. Gersh, M.B., Ch.B., D.Phil., George Dangas, M.D., Ph.D., S. Chiu 
Wong, M.D., Bernhard Witzenbichler, M.D., Giulio Guagliumi, M.D., Jan Z. 
Peruga, M.D., Bruce R. Brodie, M.D., Dariusz Dudek, M.D., Martin Möckel, 
M.D., Andrzej Ochala, M.D., Alison Kellock, B.S., Helen Parise, Sc.D., and 
Roxana Mehran, M.D. for the HORIZONS-AMI Trial Investigators 
Stone GW et al. N Engl J Med 2009;360:1946-1959. 
Kaplan–Meier Time-to-Event Curves for Primary End Points and 
Three Components of the Primary Composite Safety End Point. 
HR, 0.59; 95% CI, 0.43 to 0.83; P=0.002 HR, 1.02; 95% CI, 0.76 to 1.36; P=0.01 
HR, 0.97; 95% CI, 0.70 to 1.32; P=0.83 HR, 0.93; 95% CI, 0.59 to 1.47; P=0.77 
Drug-Eluting Stents Versus Bare-Metal Stents in Diabetic Patients 
With ST-Segment Elevation Acute Myocardial Infarction: A Pooled 
Analysis of Individual Patient Data From Seven Randomized Trials 
Rev Esp Cardiol. 2009;62(04):354-64 
Raisuke Iijimaa, Robert A Byrnea, Alban Dibraa, Gjin Ndrepepaa, Christian 
Spauldingb, Gerrit J Laarmanc, Maurizio Menichellid, Marco Valgimiglie, Emilio 
Di Lorenzof, Christoph Kaiserg, Ilkka Tieralah, Julinda Mehillia, Maarten J 
Suttorpi, Roberto Violinid, Albert Schömiga, Adnan Kastratia 
Drug-Eluting Stents Versus Bare-Metal Stents in Diabetic Patients With ST-Segment 
Elevation Acute Myocardial Infarction: A Pooled Analysis of Individual Patient Data From 
Seven Randomized Trials 
Rev Esp Cardiol. 2009;62(04):354-64 
Drug-Eluting Stents Versus Bare-Metal Stents in Diabetic Patients With ST-Segment 
Elevation Acute Myocardial Infarction: A Pooled Analysis of Individual Patient Data From 
Seven Randomized Trials 
Rev Esp Cardiol. 2009;62(04):354-64 
Drug-Eluting Stents Versus Bare-Metal Stents in Diabetic Patients With ST-Segment 
Elevation Acute Myocardial Infarction: A Pooled Analysis of Individual Patient Data From 
Seven Randomized Trials 
Rev Esp Cardiol. 2009;62(04):354-64 
Drug-Eluting Stents Versus Bare-Metal Stents in Diabetic Patients With ST-Segment 
Elevation Acute Myocardial Infarction: A Pooled Analysis of Individual Patient Data From 
Seven Randomized Trials 
Rev Esp Cardiol. 2009;62(04):354-64 
CONCLUSIONS 
In conclusion, use of DES in diabetic patients 
undergoing primary stenting for STEMI reduces the 
need for repeat intervention without increasing the 
rate of thrombosis-related events as compared to 
BMS. 
HỘI NGHỊ TIM MẠCH CAN THIỆP 
26-27/03/2016 
-- TP Huế --