Advances in StentTherapy for Ischaemic Heart Disease

Advances in StentTherapy for Ischaemic Heart Disease

Advances in Stent Therapy for Ischaemic Heart Disease Koon-Hou Mak MD, FRCP, FACC Consultant Cardiologist Gleneagles Medical Centre Singapore Advanced Biotechnology 3-Component System Stent Design Pharmacologic agent Mak Heart Drug-eluting Stent Drug carrier vehicle Stent Platform Optimal Geometry “Closed Cell” “Open Cell” 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 Mak Heart Stent-based Drug Delivery Cordis Cook Guidant + + + + + + + Boston Scientific Sorin Mak Heart BiodiYsio Matrix LO BiodiYsio Matrix HI Conor Medsytems Bionsensors JoMed Igaki-Tamai Pharmacologic Approaches Anti-inflammatory Immunomodulators Anti-proliferative QP-2, Taxol Dexamethasone Actinomycin M-prednisolone Methothrexate Interferon γ-=1b Angiopeptin Leflunomide Vincristine Sirolimus (& analogs) Mitomycine Tacrolimus Statins Mycophenolic acid C-myc antisense Mizoribine Sirolimus (& analogs) Cyclosporine RestenASE Tranilast 2-chloroBiorest deoxyadenosine PCNA Ribozyme Mak Heart Migration inhibitors ECM-modulators Promote healing and reendothelisation Batimastat Prolyl hydroxylase inhibitors Halofuginone C-proteinase inhibitors Probucol BCP671 VEGF Estradiols NO donors EPC antibodies Biorest Advanced coatings Many agents have multiple actions SIRIUS Analysis 3-year Clinical Outcome Sirolimus (n=533) Death All myocardial infarction Q-wave Non-Q-wave TLR (all) TVR (all) TVR (non-TLR) MACE TVF (1° endpoint) Mak Heart Control (n=525) P-value 3.9% (21) 4.1% (22) 1.3% (7) 2.8% (15) 6.8% (36) 11.6% (62) 7.1% (38) 12.6% (67) 15.6% (83) 2.9% (15) 4.4% (23) 0.6% (3) 3.8% (20) 23.2% (122) 27.2% (143) 9.3% (49) 27.4% (144) 30.1% (158) 0.4 0.9 0.3 0.4