1、支架内血栓In-Stent Thrombosis北京大学第一医院 李建平 Definite/Confirmed （肯定的） Acute coronary syndrome AND Angiographic confirmation of thrombus or occlusion OR Pathologic confirmation of acute thrombosis Probable （可能的） Unexplained death within 30 days Target vessel MI without angiographic confirmation of thrombosis
2、 or other identified culprit lesion Possible （不能排除的） Unexplained death after 30 daysARC 支架内血栓定义支架内血栓的预后SES (N=13)BMS (N=15)Death 4 5Myocardial Infarction 13 13Fatal MI 4 4Q Wave MI 8 5Non-Q Wave MI 5 8Similar mortality observed for SES and BMS thrombosisPooled Data from RAVEL, SIRIUS, C-SIRIUS, E-SI
3、RIUS支架内血栓发生时间ST = stent thrombosis; SAT = subacute stent thrombosis;LST = late stent thrombosis; VLST = very late stent thrombosis.Adapted from Bhatt. J Invasive Cardiol. 2019;15(suppl B):3B.Stent Thrombosis (%)支架内血栓与抗凝、抗血小板治疗ASA und TiclopidineASA und AnticoagulationASA und ClopidogrelDESASA = Acet
4、ylsalicylic acidDES: Drug-eluting stentBare Metal StentPrasugrel?BMS支架内血栓发生率Days1086420 0 30 60 120 600NEarly1.2%(N=71)Late0.4%(N=24)Study population 2019-2019-6,058 patients undergoing PCI with BMSWenaweser P et al. EHJ 2019N=1,191 N=1,855 N=361 N=6,058Stent Thrombosis (%)DES肯定的 ST发生率 :Bern - Rotte
5、rdam Cohort Study Daemen, Wenaweser et al. Lancet 2019;369:667-780.6% / yearEarly ST 91 pts(60%)Late ST 61 pts (40%)Incidence density:1.3 / 100 patient yearsN=81460 1 2 3 4Time since PCI in years012345Cumulative incidence, %Months 1 12 24 36 48Cumulative incidence, % 1.2 1.6 2.1 2.7 3.3Patients at r
6、isk 7538 7210 5164 2790 1051Incidence density1.0 / 100 pt years3.3%3.50.53% (95% CI=0.44-0.64)/ year192 definite ST casesDES肯定的 ST发生率 :Bern-Rotterdam Cohort Study 4 YearsWenaweser P et al. J Am Coll Cardiol 2019, 52, 1134-0.52% (95% CI=0.42-0.62)/ year between 30 days and 5 yearsDES肯定的支架内血栓发生率 :Bern
7、-Cohort Study 5 YearsWenaweser P et al. ESC 2019Favours DES Favours BMS180 days31-180 days0-30 daysTime after PCI.1 .2 .5 1 2 5 10 20 50 100Odds RatioFavors DES Favors BMS.1 .2 .5 1 2 5 10 20 50 100Odds RatioAdjusted Resultswith interaction terms for time since PCIEarly period: 0-30 daysOR 0.59, 95% CI .35 - 1.01Late period: 31-180 daysOR 0.52, 95% CI .16 1.75Very late period: 180 daysOR 9.4, 95% CI 2.56 34.70Wenaweser et al. ACC 2019DES vs BMSA cohort of 9,175 patients treated with either BMS or DES (SES or PES), all patients with angiographically documented ST were identified as cases
