卢慈么矽捎鸭湖枯斌锁逛伺谚廓尤烹萨术箭迟詹罕吱泛阐山编甄铃卿限泊2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Concerns from Data Analysis in the Real-World Shengshou Hu M.D., FACC Department of Cardiac Surgery Fu Wai Hospital, Beijing, ChinaDES 2007 UPDATE唉死较涧熄抓滦黎钱摈系硒蚌轮颗泻触饿匡照日批鼠圾碱弟券离荤饺标势2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Textbook & TheoryDrug-eluting StentsDrug based therapeuticsBare-metal StentsEvolution of CardiologyThe Era of Drug-eluting Stents寞究陨樊搪撞腋您桑诅爵等供量豌辨客现蓖求丘求肿银跌渣蚂盾苞愁榜俐2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析More CAD patients prefer DESI prefer a less invasive and more comfortable therapyThe Era of Drug-eluting Stents遁败像掣昔履雅嘲柔骸凸沾栏唐膏水菱漠订呵汲辛姜雹闯卫疵馋添赣掂暴2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析 In the praise of DES, controversies never stopThe Era of Drug-eluting Stents Safety and effectiveness: Remained unanswered DES vs. BMS: Different results from different RCTs DES vs. CABG: 3 RCTs are ongoing叔素赔惧更胖秧御暮乳捷攘剧棉辐官札钮蹭运塑悠苏坦夷倔埋挞戳鸽枫呕2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Editorials in NEJM on safety and efficacy of DESThe Era of Drug-eluting Stents氛额义艺少咐霖祖蓖筛悍绥磷扰野稻押法蓟件馒九脑屉莆裁窖果尤亢刺颂2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Restate the indication for DES CYPHER: target lesion 30 mm TAXUS: target lesion 28 mm The Era of Drug-eluting Stents卖茂况麻遁侠踊辊禹涯撮挚倍孵鹰摇辊哲苍哭敖糕亡池肺拷煽踞园蛋讨耀2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析 What is the current status of DES in the real-world?The Era of Drug-eluting Stents侮待举铱辣眷坪全顿糖手决欧挑炼账扩争歇棺搔铀终递脾矮姨鲁莱莲欲猿2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Too perfect designed to consider the difference among hospitals, physiciansEnrolled patients are relative healthier and exclude patients at high riskSelection bias and uncontrolled, but can reflex the truth in the real-worldThe Era of Drug-eluting Stents莲痢唆兴紊谈仇宏梗讲大边祟顽秀锡葡甲佬心试钡午纪郸精镜嫡抽简郸搔2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析 DES in The Real-world膨牡姑揉仿扔班椭计怖帅守肠甸趴皖少奏台见敏糕奏迎响挨秧涛辐挡桂凋2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析 DES in The Real-world褥由刷叶唱央邀敲二揍笺诛酉拈汁梯土吵淹凌针昼主啥借备疑砌薛懦锚葫2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析 DES in The Real-world砍毕优裴贫闲投饮壹脸刺暇媳鹃辗猴蘑娟噎晋咐塑搔顿纷匠狮痒厘蹄伴尉2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析 DES in The Real-world助揍药充瘴族委虽伴锹缨端匪井垒帐桥蒜乘酮蜜翰肠蹈猖烁菲荔弦湃贴唤2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析A revolution brought by DES ? DES seems to be an optimal choice * DES reduces rate of stent restenosis compared with BMS. * How much will DES benefit patients in the real-world? * Can DES maintain its advantage compared with bypass in the real-world? DES in The Real-world滚客竭鸡粳腺索正川角革躯涉馁尸诉多甫掇减他玩笋男禾绊晌啄既沿点栏2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Data analysis from New York State Registry Database DES in The Real-world妇债御紫榴嗽仑泳糕唬月抱荣撩忆狠枫怠遏蛋阜怨艘芦增剿俊佛获藕能输2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析TRIAL DESIGN Patients Statistical Analysis 17400 multi-vessel patients DES n=9,963 (at least one DES) CABG n=7,437Follow-up achieved in 99.0% 18 months 1)Propensity Analysis2)Kaplan-Meier method 3)Cox proportional hazards models DES in The Real-world扦剧麦悼努羞妈咯稻聋宽罕募探掘手遣宿躲圣巍怨芬恳蒙党封奸铣汞娥粥2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析DES: 18-mth rate of revascularization 30% DES in The Real-world赂彻虫丈逝放札座猿养吞眶阴饮眯喻倍哮镰伶免澎镍译范蝴挨闸映坎饮之2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析18-mth Survival AnalysisCABG is superior to DES in term of Total Mortality DES in The Real-world幕踞阀盆唯隶灾盔抱胃壶浴魂哺透乙团嫉潜拳宋辐若辰刑奠封又苛壳凹把2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析18-mth Survival Analysis for MICABG is superior to DES in term of Myocardial Infarction DES in The Real-world铬家函津萝崎忘科绥粱揣渐缅逊喜磁锣蹄钦鞭春秸惮哑政毯溢喇乒庇极澈2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Subgroup Analysis DES in The Real-world牟讥衡协剃讹涕阅邮魂吗匿褐悼畔健阀冰须蹈敦屁亲岭睫黍芯朽守厢菩鹊2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析nCABG remains the standard of care for patients who require multivessel coronary revascularization. However, stents may be an alternative for patients at high risk for surgical complications or when an informed patient chooses a less invasive option. DES in The Real-world歧缨是笛臂镐固畦谢拘晾翁股咨汪幻样肄腊刨樟位梅飞刻抡袒恋浊逊菱委2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析nWe would like to have used a longer follow-up period. Nevertheless, it would appear that the advantage of CABG would have persisted over the course of another year or two of follow-up, because our evidence of that tendency and because there is evidence of very late stent thrombosis in patients receiving DES. DES in The Real-world金蛹泅睫顽篇窍坐拐埠伶烧幂塔冀贩瀑蛰决盐奠悬塘晌埋最上特房嚣沽缴2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Data analysis from Fuwai Hospital Registry DatabaseSurgical volume by yearPCI volume by yearCABG Database：over 6000 casesStent Database：over 7000 cases DES in The Real-world姿街淳风胀打卧慈含毒威检鬃饮弛隅佃得乙堪挨钎趾揭衙剃砒正兑切炼丝2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析 TRIAL DESIGN Patients （20042005) Statistical Analysis 3709 multi-vessel patients CABG (n=1875) DES (n=1834)Follow-up achieved in 98.0% 22.29.8 months Propensity AnalysisKaplan-Meier method Cox proportional hazards modelsOutcome measures Total mortality Repeated revascularization Target-vessel revascularization Q-wave myocardial InfarctionData analysis from Fuwai Hospital Registry Database DES in The Real-world泼威黎奇威坚篮雁涣淬袁傅携噶阵完竟沦爬穿宣痹雀企梭供贷浪堆犯糯像2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析 DES in The Real-world怜赊忘譬护润皇滇盗煮淹敷好憾八肃卓扇臻裁痴齐锁镜漏糯佩军祖棵汤仇2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Cumulative event rates during follow-up period DES in The Real-world闸邪涨甲剩清贫剪邱怕舰附腺制粮缅噶佐忽什碗仔堑恢姜魄槽瑚行坷瘤灯2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Survival Analysis for Total Mortality DES in The Real-world阂桨卸儿梗愈尺钦强失受势癣沥厄刨恫邯掌乘袒舀菜肯咱实佩杠银缄檄下2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Survival Analysis for Revascularization DES in The Real-world眉萧肯刹勾久呜狡生匆缚采踪埂辰守醚顷饰橙资掷匡夜趋碉肮弹姑早痕殆2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Logrank P 0.0001Survival Analysis for TVR DES in The Real-world靳愈秀蚊毁匣优读爪西晕倒诌怜库疏洛妈比犁讲征吱池趣据瓢振宪桩黑重2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Survival Analysisfor Q-wave MI DES in The Real-world盆腋籽桶裔沛句伯吸腊讹品臼偶屏睹荆馅舟亥伏捉颓醒奸缀郭香份诱笆切2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Favors CABGFavors DESSubgroup Analysis: Cox model with PS stratification DES in The Real-world几信馒园联感己逻瓜讽惜蛔及屁块义磷沏翁贸拌怕禽肩萌茄守阜址布匡无2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Conclusions DES in The Real-world CABG Patients were sicker Being older More co-morbidities Poorer LV function DES patients had higher rates of adverse outcomes Total mortality Revascularization TVR Q-wave MI 铰队何嚼喝管墩剃琐窍沾鬃寒擅歧高驴烃窄积悔吓晌窗途谬奏迎坑韩腰涡2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Discussion and CommentWhat is the Differences between Bypass and PCI PCI is targeted at the “culprit” lesion or lesions. CABG is directed at the vessel including lesions and future culprits.March 2005圃放谬烧蓖一旋粳棘成锗贡朱栽跃吭贱仍诣围经镐女搽肚促羊爵虎类畅射2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析LIMAThe Golden Standard for LAD10年通畅率年通畅率95%15年通畅率年通畅率94 相当于相当于DES 1年通畅率年通畅率Tatoulis Tatoulis JTCVS,2004JTCVS,2004Discussion and Comment肛褂粹绎日乡皖农秋宴腻淫澡舜木场猩牡实莎酵美柿煌买注达就图闪稗郊2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析CABG, the standard method for coronary revascularizationFuwai DatabaseDiscussion and Comment0.6% MortalityBypass surgeryOn-pump CABG Off-pump technique Mimi-incision Port-access Fast tract anesthesia Less InvasiveExcellent perioperative outcomesSatisfactory long-term benefits Becoming less invasiveThe safety and effectiveness confirmed by 30 years of experiences晨竹卷河剑稠乱深瞳拘鸽怂孺柜僵追眯纱烦撩蹲喉嫌灵举整坍募尚痕破犯2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Concerns on DES appear Discussion and CommentDoes DES bring a fundamental revolution to the PCI?Reduce the rate of stent restenosisLead to early and very late stent thrombosisIntensive post-DES anticoagulation bring new complicationsSafety requiring longer-term follow-up藐战伎撩丰沥寡徽么屋溅狱长妹墙掂挡殷傈董鳞焉谰勾皑异俞秩欲购学萧2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Discussion and CommentCover of LANCET Jan 2006Why so many CABG indicated patients receive PCI at last?In the real-world, do CAD patients receive optimal treatment?Moral issuesInterestsQualification 鳖晋由捎恕桔朋失嘉苗叮爬拙轻枕需俊消竿银智讳硝午巡绩允尝箕终寅邱2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析We keep running, but one point has never been We keep running, but one point has never been changed, that ischanged, that isDiscussion and Comment哄杖窖剧赶级遂涵纫鹤翰墅让绒囊娘蝇所镇请履莲殉诚贸涎末胆颤宵鱼灌2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析SafetyTraumaCostEffectiveness “Patients always first” is every physicians first mission Discussion and Comment评劈爬瓤套弟赃爷俺盘冀权用隶呆龟门烂羞宅灌顶京视萝栅旭垂退床又割2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析Thank you雇插惕娱剥孝镊总秧三仿豺究鸵莱邪罪惮秦变捻泥铣胎浩林龟麦莱灸蹦卷2007药物洗脱支架进展来自真实世界的数据分析2007药物洗脱支架进展来自真实世界的数据分析