Prof. Yean L. Lim AM Professor 370:937-48.Efficacy of DES Reduced Target Lesion RevascularizationNetwork Analysis HR 0.70Windecker S, ACC 2008 ChicagoPCI for CAD: 2008 ConsiderationsRevascularization therapy for CAD, Who & When ?If Revascularization indicated, PCI or CABG ?If PCI, DES or BMS ?Complex PCI Strategy (STEMI, LM, MVD, Diabetic, Bifurcation CTO)Kastrati ACC 2008Clopidogrel600mg as early as possible could be helpful Abciximabstill needed for high-risk ptsFacilitation Upstream GP2b3a Inhibitorno clinical benefit over in lab Full-dose fibrinolyticsHarmful Half-dose lytic + GP2b3a InhHarmfulPrimary PCI for STEMI STEMI 介入特点多取岀少放入BMS or DES for Primary PCI for STEMIWhen to use DES for PPCIEarly onset STEMIHigh risk of restenosisAfter Thrombo-aspirationAfter Pre-dilatationUNPROTECTED LEFT MAIN LESIONUnprotected LM : PCI or CABGFuture of PCI for CADPCI Milestones:1977: POBA1990: BMS2000: DES2008: ? Bioabsorbable DESOCT of BVS stent: Normal vessel function after 2 yearsP. Serruys, Great Minds Symposium, Cairns, July 2008Conclusion Early PCI for ACS but deferred PCI for Stable Angina, unless large reversible ischemic burden presentPCI for all who need revascularization except Diabetics, ULM or when where CABG is contraindicated or unavailableThrombus aspiration followed by stenting ( ? DES) for Primary PCI for eligible STEMIPCI for CTO should not be based only on anatomyBioabsorbable stents ? Next PCI breakthrough Thank You