Drug-Eluting Stents for Multivessel PCI

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SOLACI Chile Congress 2011. Dr.Ajay Kirtane. Drug-Eluting Stents for Multivessel PCI: Indications and Outcomes. Find more presentations on the web site: www.solaci.org/

Transcript of Drug-Eluting Stents for Multivessel PCI

  • 1. Ajay J. Kirtane, MD, SMCenter for Interventional Vascular TherapyColumbia University Medical Center /New York Presbyterian HospitalDrug-Eluting Stents forMultivessel PCI:Indications and Outcomes
  • 2. Conflict of Interest Disclosure Ajay J. Kirtane None Off-label use will be discussed
  • 3. Two Goals of Therapy inPatients with Stable CAD1. Improve Symptoms and Qualityof Life Measured by soft endpoints(i.e. angina/QOL scales)2. Improve Prognosis Measured by hard endpoints(i.e. death, MI)
  • 4. It is generally accepted thatrevascularization makes symptomaticpatients feel better but it is also aFACT that The Presence of Severe CADis Prognostically Important! Lets not forget our History Workload / Exercise Tolerance Burden of Disease / Ischemia Patients with prior MI / DecreasedVentricular Function may haveeven more to gain / or lose
  • 5. Meta-Analysis of CABG vs. MedicalTherapy: 7 RCTsYusuf S et al, Lancet 1994Mortality
  • 6. 6.7%3.7%3.3%1.0%2.9%4.8%1.8% 2.0%0%2%4%6%8%10%Medical Rx RevascMitigatated Gradient with Revasuclarization% Total Ischemic Myocardium1- 5% 5-10% 11-20% >20%CardiacDeathRate1331 56 718 109 545 243 252 267P 13.0%,Cl III or IV HFHepatic dysfunctionPCI or CABG w/i 1 yrA study of prophylactic revascularization among patientswith no definite need for invasive interventionThe BARI 2D Study Group.NEJM 2009;360:2503-15
  • 10. BARI 2D: CABG StratumSurvival Freedom from MACE(death, MI, or stroke)Survival(%)YearsEvent-freeSurvival(%)YearsP=0.330 1 2 3 4 5020406080Medical TherapyRevascularization83.686.4N at Risk 763 734 718 692 586 333100P=0.010 1 2 3 4 5020406080Medical TherapyRevascularization69.577.6N at Risk 763 668 634 568 421 230100The BARI 2D Study Group.NEJM 2009;360:2503-15
  • 11. BARI 2D: Who got Revascularized?PCI Stratum CABG Stratum pN=1176 N=1192USA 73.7% 41.4%