Ứng dụng của stent tự tiêu trong can thiệp mạch vành cấp

9-11th Oct 2016, Hanoi 15th VNCC Bioabsorbable Vascular Scaffolds in Primary PCI Koh Tian Hai National Heart Centre, Singapore Conflicts of Interest ► Nil with regards to this presentation HORIZONS Trial: PES vs BMS at 30 days TLR, all cause mortality & Stent Thrombosis: Ischaemic TLR Ischaemic TLR & angio follow-up No angio follow-up All cause mortality Stent Thrombosis GW Stone et al Lancet2011; 377:; 2193-204 Absorb III Trial 2008 pt Randomised 2:1 BRS vs EES end pt: TLF at yr for non-inferiority and superiority SG Ellis et al NEJM 2015; 373: 1905-15 ABSORB III – Target Lesion Failure at yr Non Inferior TLF: Card Death, TV-MI, ID-TLR SG Ellis et al NEJM 2015; 373: 1905-15 Safety & Efficacy Outcomes at 1yr SG Ellis et al NEJM 2015; 373: 1905-15 Safety & Efficacy Outcomes at 1yr SG Ellis et al NEJM 2015; 373: 1905-15 Why BRS in STEMI? ► Young patient: benefit from long term freedom from permanent stent caging ► Vasomotion recovery ► Favourable long term remodelling ► Potential plaque sealing Young Man, smoker, with sudden chest pain Case courtesy of Dr Jack Tan, NHCS BRS in STEMI How good are BRS? Expected Benefits Angio illustrations-BRS, Mg BVS Case cine cine Pre PCI: Moderate long eccentric Typical exertional angina cine cine Pre PCI: Moderate long eccentric Typical exertional angina cine cine Pre PCI: Moderate long eccentric Typical exertional angina cine cine Pre PCI: Moderate long eccentric Typical exertional angina cine cine Pre PCI: Moderate long eccentric Typical exertional angina cine cine Pre PCI: Moderate long eccentric Typical exertional angina cine cine Pre PCI: Moderate long eccentric Typical exertional angina cine cine ... vs BMS at 30 days TLR, all cause mortality & Stent Thrombosis: Ischaemic TLR Ischaemic TLR & angio follow-up No angio follow-up All cause mortality Stent Thrombosis GW Stone et al Lancet2011;... 2015; 373: 1905-15 Why BRS in STEMI? ► Young patient: benefit from long term freedom from permanent stent caging ► Vasomotion recovery ► Favourable long term remodelling ► Potential plaque sealing... et al IJC 2016 Potential Risks of BRS implants in STEMI ► Thrombogenic ► Large milieu promotes Stent Thrombosis profile device promotes abnormal sheer stress-> ST ► Potential for acute malapposition