Lựa chọn stent phủ thuốc hay không phủ thuốc

Can thiệp cấp cứu động mạch vành:
lựa chọn stent trần hay stent phủ thuốc
-----------------TS. Nguyễn Cửu Lợi
Trung tâm Tim mạch – Bệnh viện Trung Ương Huế



Paclitaxel-Eluting Versus Conventional Stent in Myocardial
Infarction with ST-Segment Elevation [PASSION]
• Randomly assigned 619 patients presenting with STEMI to a
paclitaxel-eluting stent (PES) or the similar BMS.
• The primary end point was the composite of cardiac death,
recurrent myocardial infarction, or TLR.
• Follow-up at 5 years.

Maarten A. Vink, Maurits T. Dirksen, Maarten J. Suttorp, Jan G.P. Tijssen, Jeroen van Etten,
Mark S. Patterson, Ton Slagboom, Ferdinand Kiemeneij, Gerrit J. Laarman.




Paclitaxel-Eluting Versus Conventional Stent in Myocardial Infarction
with ST-Segment Elevation [PASSION]

Conclusions
In the present analysis of PES compared with BMS in primary
percutaneous coronary intervention for STEMI:
- No significant difference in major adverse cardiac events
was observed.
- In addition, no difference in the incidence of definite or
probable ST was seen, although very late ST was almost

exclusively seen after the use of PES.

J Am Coll Cardiol Intv 2011;4:24–9




Events %




- 3980 (63.2%) DES (99% PES & SES)
- 2318 (36.8%) BMS




2012 Apr;33(8):977-87

Comparison of drug-eluting stents with bare metal stents in
patients with ST-segment elevation myocardial infarction
(15 RCT)
Bindu Kalesan, Thomas Pilgrim, Katja Heinimann, Lorenz Räber, Giulio G. Stefanini, Marco Valgimigli,
Bruno R. da Costa, François Mach, Thomas F. Lüscher, Bernhard Meier, Stephan Windecker, Peter Jüni


Comparison of drug-eluting stents with bare metal stents in patients with ST-segment
elevation myocardial infarction (cont’)

Overall

Year 1

Subsequent year


Comparison of drug-eluting stents with bare metal stents in patients with ST-segment
elevation myocardial infarction (cont’)

Overall

Year 1

Subsequent year


Comparison of drug-eluting stents with bare metal stents in patients with ST-segment
elevation myocardial infarction (cont’)


Comparison of drug-eluting stents with bare metal stents in patients with ST-segment
elevation myocardial infarction (cont’)

CONCLUSION
An early benefit of early generation DES in primary
PCI for STEMI with a reduction in TVR and a trend
towards less definite ST is offset in subsequent years
by an increased risk of very late ST.

Bindu Kalesan, Thomas Pilgrim, Katja Heinimann, Lorenz Räber, Giulio G. Stefanini, Marco Valgimigli,
Bruno R. da Costa, François Mach, Thomas F. Lüscher, Bernhard Meier, Stephan Windecker, Peter Jüni


Paclitaxel-Eluting Stents versus Bare-Metal Stents
in Acute Myocardial Infarction

Gregg W. Stone, M.D., Alexandra J. Lansky, M.D., Stuart J. Pocock, Ph.D.,
Bernard J. Gersh, M.B., Ch.B., D.Phil., George Dangas, M.D., Ph.D., S. Chiu
Wong, M.D., Bernhard Witzenbichler, M.D., Giulio Guagliumi, M.D., Jan Z.
Peruga, M.D., Bruce R. Brodie, M.D., Dariusz Dudek, M.D., Martin Möckel,
M.D., Andrzej Ochala, M.D., Alison Kellock, B.S., Helen Parise, Sc.D., and
Roxana Mehran, M.D. for the HORIZONS-AMI Trial Investigators


Kaplan–Meier Time-to-Event Curves for Primary End Points and
Three Components of the Primary Composite Safety End Point.
HR, 0.59; 95% CI, 0.43 to 0.83; P=0.002

HR, 1.02; 95% CI, 0.76 to 1.36; P=0.01

HR, 0.97; 95% CI, 0.70 to 1.32; P=0.83

HR, 0.93; 95% CI, 0.59 to 1.47; P=0.77

Stone GW et al. N Engl J Med 2009;360:1946-1959.