DRUG-COATED BALLOON IN PRIMARY PCI FOR STEMI Ho Hee Hwa Background  Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy for ST elevation myocardial infarction (STEMI)  Associated with higher reperfusion rates (vs lytic)  ↓ rates of reinfarction, CVA and death  Started with primary angioplasty (POBA) Associated with abrupt closure, recurrent ischaemia ; occlusion and restenosis at mths PAMI-STENT(1999) Routine implantation of bare metal stents associated with ↓ TVR mth mortality rate was similar CADILLAC STUDY (2002) Routine implantation of bare metal stents associated with ↓ TVR mth mortality rate was similar Use of DES in PPCI for STEMI  Trials evaluating use of DES in AMI (Typhoon, Passion, Sesami,etc)  Meta-analysis of trials: similar mortality benefit compared to BMS but ↓TLR in DES  Recent trial : Comfortable AMI (risk of MACE at year lower with the biodegradable polymer BioMatrix stent Drug-eluting stents in AMI DES BMS (RCTs) TLR P =0.006 P DEB Bare Metal Stent (BMS) PCI Cycle 1990s 2010 Bioabsorbable Scaffold Drug Eluting Stent (DES) 2000 Conclusion  Use of DEB in PPCI for STEMI ( as primary therapy/adjunctive therapy) is feasible in selected grp of pts  Can be used in de novo, VLST and adjunctive therapy  Careful patient selection Tips and tricks in using DEB in PPCI  PCI approach: aspirate >> predilate >> DEB  Gp2b/3a inhibitors  Know how to grade dissection THANK YOU PAPPA study  EuroIntervention 2014 Sep;10(5):584-90  Safety and feasibility of a PAclitaxel-eluting balloon angioplasty in Primary Percutaneous coronary intervention in Amsterdam (PAPPA): one-year clinical outcome of a pilot study  MACE at year is low – 5%  deaths and TLRs PAPPA study  Recruited 100 patients  59 patients – DCB-only ; High rate of bail- out stenting – 41 pts (41%)  Thrombus aspiration (96%)  Predilatation  DCB (Pantera Lux) with B:V > 1.1 ; minimum 60s DES vs BMS NEJM Sept 2016 NORSTENT Study NEJM Sept 2016 TTSH PPCI DEB Registry Target lesion revascularisation: N=5 - All patients underwent CABG - cases of “true” restenosis - underwent CABG as part of revascularisation strategy for TVD DEB for de novo lesion SP 2.5*26 SP 3.0*17 Acute Closure  No acute closure in our study  Careful patient selection ... (DEB+BMS)  Post PCI TIMI flow TIMI TIMI  Residual stenosis (%) N/(%) 93 (96) (4) (2) 95 (98) 27 + 14 TTSH PPCI DEB Registry  PCI details: N/(%) 53 + 21 s 10 + atm Inflation time Inflation... PPCI-DEB Registry Clinical Efficacy and Safety of Drug-Coated Balloon Angioplasty as Primary Therapy in PPCI PPCI Strategy for DEB Aspirate + Predilate Dissection Type A-B TIMI flow Residual stenosis... Residual stenosis < 30% TIMI thrombus grade 1-2 DEB PPCI Strategy for DEB  Bail-out stenting when there is significant recoil/dissection ( > type B) TTSH PPCI DEB Registry     Study Period: Jan