支架内血栓发生时间ST=stentthrombosis
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OR – Pathologic confirmation of acute thrombosis]
• Probable （可能的）
– Unexplained death within 30 days – Target vessel MI without angiographic confirmation of
BMS支架内血栓发生率
10 Early Lwenku.baidu.comte 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
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 Late ST 91 pts 61 pts (60%) (40%)
SES (N=13)
4 13 4 8 5
BMS (N=15)
5 13 4 5 8
Similar mortality observed for SES and BMS thrombosis
Pooled Data from RAVEL, SIRIUS, C-SIRIUS, E-SIRIUS
支架内血栓发生时间
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
支架内血栓 In-Stent Thrombosis
北京大学第一医院 李建平
ARC 支架内血栓定义
• Definite/Confirmed （肯定的）
– Acute coronary syndrome AND – [Angiographic confirmation of thrombus or occlusion
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
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.
thrombosis or other identified culprit lesion
• Possible （不能排除的）
– Unexplained death after 30 days
支架内血栓的预后
Death Myocardial Infarction
Fatal MI Q Wave MI Non-Q Wave MI
%
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
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
OWeRnaw9e.s4er,et9aO5l.dA%dCsCRC2a0I0ti72o .56 – 34.70
Odds Ratio
Very Late ST > 1 Year (Per Protocol)
Sirolimus-Eluting Stent
% P=0.75
Paclitaxel-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-
5
192 definite ST cases
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
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
• Probable （可能的）
– Unexplained death within 30 days – Target vessel MI without angiographic confirmation of
BMS支架内血栓发生率
10 Early Lwenku.baidu.comte 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
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 Late ST 91 pts 61 pts (60%) (40%)
SES (N=13)
4 13 4 8 5
BMS (N=15)
5 13 4 5 8
Similar mortality observed for SES and BMS thrombosis
Pooled Data from RAVEL, SIRIUS, C-SIRIUS, E-SIRIUS
支架内血栓发生时间
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
支架内血栓 In-Stent Thrombosis
北京大学第一医院 李建平
ARC 支架内血栓定义
• Definite/Confirmed （肯定的）
– Acute coronary syndrome AND – [Angiographic confirmation of thrombus or occlusion
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
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.
thrombosis or other identified culprit lesion
• Possible （不能排除的）
– Unexplained death after 30 days
支架内血栓的预后
Death Myocardial Infarction
Fatal MI Q Wave MI Non-Q Wave MI
%
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
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
OWeRnaw9e.s4er,et9aO5l.dA%dCsCRC2a0I0ti72o .56 – 34.70
Odds Ratio
Very Late ST > 1 Year (Per Protocol)
Sirolimus-Eluting Stent
% P=0.75
Paclitaxel-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-
5
192 definite ST cases
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
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