Choice of stent for AMI patients The University of Tokyo Hospital Jiro Ando, MD Which Stent we can use in AMI BMS or DES ? The Concept Stent design and delivery system Pharmacologic agent Drug- Eluting Stent Drug-Eluting Stents Drug carrier vehicle The Cypher Sirolimus-Eluting Stent Bx VELOCITY TM Stent • Balloon expandable stainless steel stent • Blend of components: 2 polymers (PEVA + PBMA) and sirolimus in a fixed ratio • Thin uniform coating (~ 10um thick) 0% 5% 10% 15% 20% 25% 30% 0 365 730 1095 1460 1825 Bare Metal Stent (n=870) CYPHER Stent (n=878) p<0.0001 9.6% (80) 23.9% (205) Days Number at risk BMS CYPHER 870 877 680 827 659 797 632 766 603 732 518 645 RAVEL, SIRIUS, E-SIRIUS, C-SIRIUS Kirtane A. TCT 2007. Adapted from Stone GW et al. NEJM 2007;356:998–1008 CYPHER vs. BMS: TLR Pooled Analyses of 4 RCTs 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 0 365 730 1095 1460 1825 Bare Metal Stent (n=870) CYPHER Stent (n=878) p=0.99 2.1% (17) 2.0% (17) Days Number at risk BMS CYPHER 870 878 848 858 834 835 813 809 784 783 683 694 RAVEL, SIRIUS, E-SIRIUS, C-SIRIUS Pooled Analyses of 4 RCTs CYPHER vs. BMS: ARC def/prob ST* * ARC def/prob ST counts all ST Vascular responses in porcine models BMS or DES ? • BMS Stented region is good Covered with neointima , and we can reduce DAPT in early term . • First generation DES stented region isn’t covered well with neointima , and we continue DAPT in long term. • But BMS result of restenosis rate is higher than DES. How about Second generarion DES in ACS and DAPT ? [...]...EXAMINATION randomized trial Everolimus-eluting stent vs Bare-metal stent in ST-segment elevation myocardial infarction 2-year results of the EXAMINATION randomized trial 2-year results of the EXAMINATION randomized trial ― Stent Thrombosis ― The COMFORTABLE AMI Randomized Trial To compare stents eluting biolimus from a biodegradable polymer with bare-metal stents in primary PCI 2-year results of. .. TVR TVF: composite of cardiac death, target vessel MI and clinically driven TVR TLF = composite of cardiac death, target vessel MI and clinically driven TLR TLF TVF Conclusions • 2nd generation DES is good result for ACS ,and also the risk of thrombotic occulusion is low • Many of New generation DES will be released , we should check the results of those study and choice good DES for patient ... bare-metal stents in primary PCI 2-year results of the Conformatble AMI CENTURY II Trial Demonstrate the safety and efficacy of the Ultimaster by comparing with Xience CENTURY II Trial CENTURY II – High risk ACS Total population n=1119 BP-SES n=562 PP-EES n=557 Randomization 1:1 Acute Coronary Syndrome n=264 BP-SES n= 126 patients/ 166 lesions PP-EES n= 138 patients 205 lesions Clinical outcomes at 12 months