Vai trò của stent tự tiêu trong hội chứng vành cấp

14th VNCC Danang 10-14 Oct 2014 Bioresborbable Scaffolds in Acute Coronary Syndromes Koh Tian Hai Senior Consultant, Dept of Cardiology Senior Advisor National Heart Centre, Singapore Conflicts of Interest • Abbott – trial grant & travel support • BSC, Biosensors- travel support 2014 ESC Guideline on evaluation & revascularisation in ACS S Windecker , P Kolh et al EHJ 2014; 35: 2541-2619 DES with randomised Trials with primary clinical endpoint - ESC S Windecker , P Kolh et al EHJ 2014; 35: 2541-2619 Some Current BRS undergoing trials A Lelasi & M Tespii Fut Card 2014; 10: 409-20 Attractiveness of BVS • Vessel enlargement • Vasomotor restoration • Completely dissolvable- uncaging of vessel – Feasible for future CABG options • Permits assessment with non-invasive CT angiography BRS: Late Lumen Enlargement P W Serruys at TCT 2013 Porcine Model-IVUS: Increase in Lumen area: BVS vs EES after 12mths 70 pigs with 109 BVS and 70 EES implanted in various arteries; Serial angio, IVUS and histomorphometry at various timepoints 1-42 mths JP Lane et al JACCIntv 2014; 7: june online Porcine IVUS : Increase in lumen area after 12mth & pulsatility with BVS vs EES after 6mth JP Lane et al JACCIntv 2014; 7: june online Plaque Sealing with BRS P W Serruys at TCT 2013 ABSORB II at 1yr: Stent Thrombosis (Define or Probable) Absorb N=335 EES N=166 P=0.55 PW Serruys et al Lancet; online 14 Sept 2014 Ghost Multicentre Registry-1189 patients Def/Prob Scaffold Thrombosis to mths ST= 1.5% at 30 days, 2.1% at mths D Capodanno et al EuroIntv 2014 July online Conclusions : BRS in ACS • BRS implantation seems feasible in ACS patients • Stent thrombosis seems to be of some concern in nonrandomised real-world BRS studies – appears higher than latest generation of DES • Vessel sizing important to prevent malapposition • Better low profile device needed • Major randomised BRS studies in ACS needed, with hard clinical endpoints st 21 to th 24 January 2015 Thank You C Tamburino @ TCT 2014 DES with angio efficacy data S Windecker , P Kolh et al EHJ 2014; 35: 2541-2619 Biosolve I: Vasoreactivity at mths M Haude at EuroPCR may 2014 [...]... Cohort A: MACE to 5 years 30 patient Cohort No MACE beyond 6 months No cardiac deaths No Stent Thrombosis All 18 pts with MSCT at 5yrs show patent Scaffolds Y Onuma et al JACCIntv 2013; 6:999-1009 Why do we need to implant BVS in ACS? • Younger patients, less Coro Atherosclerosis – Free patients from permanent stents • Does not obviate CABG for long lesions • ? Long term reduction in need for antiplatelet... EES N=166 P=0.28 PW Serruys et al Lancet; online 14 Sept 2014 R Dilleti @ BRS 2014 Should we stent the Vulnerable Plaque? A Arbb-Zadeh et al Circ 2012; 25: 1147-56 PROSPECT STUDY GW Stone et al NEJM 2011; 364: 226-35 GW Stone @ BRS 2014 GDMT=guideline determined med therapy GW Stone @ BRS 2014 ABSORB II at 1yr: Stent Thrombosis (Define or Probable) Absorb N=335 EES N=166 P=0.55 PW Serruys et al Lancet;... patients Def/Prob Scaffold Thrombosis to 6 mths ST= 1.5% at 30 days, 2.1% at 6 mths D Capodanno et al EuroIntv 2014 July online Conclusions : BRS in ACS • BRS implantation seems feasible in ACS patients • Stent thrombosis seems to be of some concern in nonrandomised real-world BRS studies – appears higher than latest generation of DES • Vessel sizing important to prevent malapposition • Better low profile