ステントれるなら - JSEPTIC

1 BMS DES ICU 2014/01/21 .. PCI PCI 2004 (DES) BMS .. 2007 ACA/AHA DES 1 2 PCI DES 1 , BMS 4 6 .. 1 2 60 PCI 12- 23% DES 2 A report from the cathpci through June 2011 ;126(11):1355- 1362 ACA/AHA ACC/AHA .. MACE BMS DES (Major Cardiac Adverse Events ) Cardiovasc ;(3):920- 927 ;126(11):1355- 1362 ;310(14):1462-1472 Objective PCI MACE Design,Setting,Participants 2000 2010 ,PCI 2 41989 MACE Nested case control study MACE 2000- 2010 124844 PCI 28029 study 41989 2 ( ) 1980 30 MACE ( ) MI, PCI 1170 MI, PCI 141 669 Result 30 MACE , rCRI ( , , , , DM, )

2 6 MI CHF 6 CHF 30 MACE DM 1 CKD 30 MACE 30 MACE BMS DES 2 PCI MACE 30 MACE 30 MACE MACE , MACE ASA Class, MACE ,6 MI ,rCRI 3 Odds Ratio / ,6 CHF Odds Ratio , Odds Ratio MACE 6weeks 6 BMS>DES 6 MACE MACE MACE rCRI MACE Revised cardiac risk index MACE 6 MI MACE 6 MI MACE 30 MACE MACE APT APT APT 5 DISCUSSION MACE 6 MACE 6 MACE risk factor (CHF MI) ( ) DES MACE risk Limitation , PCI MACE Nested Case- Control Study.

3 Incidence and Outcome of Surgical Procedures After Coronary Bare- Metal and Drug- Eluting Stent Implantation: A Report From the CREDO- Kyoto PCI/CABG Registry Cohort- 2 Circ Cadiovasc ;5:237- 246 Design: 2005 1 2007 12 , , Objective: 30 , Patients: PCI 12207 30 30 ( / / / ) BMS,DES 2 Risk of Elective Major Noncardiac Surgery After Coronary Stent Insertion: A Population- Based Study ;126:1355- 1362 Design:2003 1 2009 12 , , Objective: 30 ,1 MACE Patients: 10 PCI 40 8116 BMS 46 180 DES 180 BMS 181 365 DES 45 MACE Perioperative Management of Antiplatelet Therapy in Patients With a Coronary Stent Who Need Noncardiac Surgery A Systematic Review of Clinical Practice Guidelines CHEST 2013.

4 144(6):1848- 1856 Design: 1946 2013 1 systematic review (National Guideline Clearinghouse website, MEDLINE, EMBASE, AMED, Cochrane Library) 11 Guidelines Objective: PCI , bridging PCI BMS 4weeks DES 6months GL 4 GL 5 2 GL 7- 10 , bridging 5 GL bridging Design:2003- 2007 retrospective cohort study Objective: 3 (< 42 days, 42 days ~ 1year, 1 year <) Patients: Total 1953 BMS 1383 ,DES 570 Previous Coronary Stent Implantation and Cardiac Events in Patients Undergoing Noncardiac Surgery Circ Cardiovasc ;3:236- 242 42 BMS vs DES Figure BMS DES 42 ACS stable IHD ACS 65 % vs 32%, P= BMS 899 DES 520 400 BMS % DES 1 6 % BMS 30 90 90 DES 1 DES Time and Cardiac Risk of Surgery after Bare- metal Stent Percutaneous Coronary Intervention Anesthesiology 2008;109:588- 95 Cardiac Risk of Noncardiac Surgery after Percutaneous Coronary Intervention with Drug- eluting Stents Anesthesiology 2008.

5 109:596- 604 Objective DES 11 Design multicenter prospective study Setting 19 US centers Patients 2003 1 2004 6 MI 2498 Methods 1 DES thienopyridine therapy 12 follow up 500 Prevalence, Predictors, and Outcomes of Premature Discontinuation of Thienopyridine Therapy After Drug- Eluting Stent Placement Results From the PREMIER Registry Circulation 2006;113:2803- 2809 DES 1 thienopyridine therapy(TT) 11 DES 1 TT 11 Objective DES versus BMS ( , ) Design singlecenter prospectively study Patients 2003 5 2004 5 MI 988 BMS ,DES Methods 6 2 ,6 follow up(7- 18 ) Late Clinical Events After Clopidogrel Discontinuation May Limit the Benefit of Drug- Eluting Stents JACC 2006.

6 48:2584- 91 12 DES Death/Non- fatal MI DES 1 2 postPCI 30 ( ,MI,ST,stroke, , ) BMS vs DES , APT2 postPCI 42 , BMS vs DES BMS 46 180days or 4weeks DES 180 MACE BMS 181 365 , DES 45 PCI ,6 MACE