PCI for multi-vessel CAD - Đinh Đức Huy
Backgrounds- Most trials comparing PCI with CABG have not made
use of 2nd -generation drug-eluting stents.
The primary end point =
composite of death, MI, or TVR at 2 years after randomization
Tóm tắt nội dung PCI for multi-vessel CAD - Đinh Đức Huy, để xem tài liệu hoàn chỉnh bạn click vào nút "TẢI VỀ" ở trên
PCI for multi-vessel CAD when & how? Dinh Duc Huy, MD, FSCAI Tam Duc Heart Hospital 2 Very different ways to treat 1 disease Gersh and Frye. New Engl J Med 2005;352:2235 PCI versus CABG: ASCERT Registry Weintraub, et al. New Engl J Med 2012;366:1457-76 189,000 stable patients =65 years old treated with either PCI or CABG Impact of diabetes Impact of age Meta-Analysis of 10 randomized CABG vs. PCI trials- 7000 patients Hlatky, et al. Lancet 2009;373:1190-97 1800 patients with 3 vessel CAD randomized to PCI with Paclitaxel DES or CABG SYNTAX study- 5 year outcomes Mohr, et al. Lancet 2013;381:629-38 Mortality MI Stroke MACCE Impact of Syntax Score Serruys, et al. N Engl J Med 2009;360:961-72 Farkouh, et al. N Engl J Med 2012;367:2375-84 Freedom trial- long term outcomes 1900 diabetics enrolled from 140 centers with mostly 1st generation DES Backgrounds- Most trials comparing PCI with CABG have not made use of 2nd -generation drug-eluting stents. The primary end point = composite of death, MI, or TVR at 2 years after randomization Park S J. N Engl J Med 2015;372:1204-12 BEST study- main results Park S J. N Engl J Med 2015;372:1204-12 • 27 centers in East Asia • 880 patients • 438 in PCI group • 442 in CABG group • MACEs was higher among those who had undergone PCI with the use of Everolimus-DES than among those who had undergone CABG Long- term clinical outcomes end points Park S J. N Engl J Med 2015; 372:1204-12 Subgroup analysis- Impact of Diabetes, Syntax score, EuroSCORE Park S J. N Engl J Med 2015;372:1204-12 1st message: PCI is good in patients with young age, less complex CAD (low Syntax score), and non-diabetic. PCI for multi-vessel CAD Bangalore S. N Engl J Med 2015;372:1213-22 Same data from New York State registry- Everolimus-eluting stent or bypass surgery for multi vessel coronary disease? PCI CABG HR (95%CI) P value Complete Revascularization N=1911 N=1911 Death at 3 year 2.54% 2.5% 1.08 (0.82-1.42) 0.58 Myocardial infarction 1.43% 1.37% 1.02 (0.71-1.47) 0.93 Stroke 0.42% 0.84% 0.43 (0.24-0.75) 0.003 Revascularization 5.46% 3.4% 1.55 (1.26-1.9) <0.001 Incomplete Revascularization N=7312 N=7312 Death 3.25% 2.96% 1.03 (0.91-1.17) 0.63 Myocardial infarction 1.98% 1.07% 1.66 (1.39-1.98) <0.001 Stroke 0.80% 1.01% 0.66 (0.52-0.83) 0.0004 Revascularization 7.70% 3.03% 2.59 (2.34-2.88) <0.001 Complete versus Incomplete Revascularization from New York Registry PCI CABG HR (95%CI) P value Complete Revascularization N=215 N=295 Death at 5year 7.0% 4.4% 1.50 (0.71-3.15) 0.29 Myocardial infarction 2.3% 3.1% 0.75 (0.25-2.24) 0.60 Death , MI or Stroke 11.6% 9.5% 1.18 (0.69-2.02) 0.55 Any repeat revascularization 6.5% 3.4% 1.89 (0.84-4.25) 0.13 MACE 16.7% 12.2% 1.34 (0.84-2.13) 0.22 Incomplete Revascularization N=215 N=122 Death 6.5% 5.7% 1.22 (0.49-3.02) 0.68 Myocardial infarction 7.4% 1.6% 4.85(1.11-21.1) 0.036 Death , MI or Stroke 12.6% 9.0% 1.52(0.75-3.07) 0.24 Any repeat revascularization 15.8% 10.7% 1.58 (0.83-3.00) 0.16 MACE 23.7% 16.4% 1.59 (0.94-2.66) 0.08 Complete versus Incomplete Revascularization from BEST study 2nd message: Complete Revascularization is important practical issue. PCI for multi-vessel CAD FAME Study: Angio-guided verus FFR-guided PCI 1005 patients with 2-3 vessel CAD randomized to Angio or FFR-guided PCI Fearon W. New Engl J Med 2009;360:213-24 Without FFR With FFR Functional SYNTAX Score- Reclassifies > 30% of cases Nam CW, et al. J Am Coll Cardiol 2011;58:1211-8 FFR- guided PCI versus CABG- FAME 3 study Is FFR-guided PCI with the 2nd -generation Resolute DES non-inferior to CABG in patients with multi vessel CAD? 3rd message: Ischemic-guided (by FFR) PCI may lead to better outcomes PCI for multi-vessel CAD ESC Guidelines 2014 Elective PCI for 3 Vessel Disease CABG PCI Recommendation According to extent of CAD Class Level Class Level 3 VD with SYNTAX score ≤ 22 I A I B 3 VD with SYNTAX score 23-32 I A III B 3 VD with SYNTAX score > 32 I A III B Thank you for your attention!
File đính kèm:
pci_for_multi_vessel_cad_dinh_duc_huy.pdf
