RESEARCH, REDUCE III, X-AMINE ST, COOL-MI

1. RESEARCH, REDUCE III, X-AMINE ST, COOL-MI Azfar Zaman Freeman Hospital, Newcastle

2. 1. Rapamycin Eluting Stent Evaluated At Rotterdam Cardiology HospitalRationale • Sirolimus eluting stents reduce restenosis and reintervention • Increased risk of early and late stent thrombosis • Are SES safe and effective in a thrombogenic environment post STEMI? RESEARCH

3. Recruitment • 96 patients with STEMI enrolled as part of registry of SES implantation in Rotterdam • ACT>300 (200-250 with IIb/IIIa) • Clopidogrel between 3-6 months RESEARCH

4. Results • MACE (death, nonfatal MI, reintervention) + 6 m angiogram • mean age 57y, IIb/IIIa in 46.9% • ref. diameter 2.73 ± 0.59, length 16.9 ± 9.95 mm • No early or late stent thromboses • No reinterventions and no restenosis RESEARCH

5. Relevance • Single centre registry data but unrestricted • NICE (DES >15mm/<3mm) “except if MI in preceding 24h or evidence of thrombus” • Supporting evidence for safe use (of sirolimus) in MI – “need larger studies” RESEARCH

6. 2. Restenosis Reduction by Cutting Balloon Evaluation IIIRationale • Failure of CB to reduce angiographic or clinical outcomes in ISR (versus standard balloon) • Can predilation with CB versus standard balloon before bare metal stent deployment reduce restenosis ? REDUCE III

7. Recruitment • Randomised, multicentre (Japan) • 521 patients • Mean age 65 years REDUCE III

8. Results REDUCE III

9. Relevance • A role for cutting balloon……at last? • DES for “NICE” lesions, CB plus BMS for others • Promising…….2 years too late? REDUCE III

10. 3. X-Sizer in AMI patients for Negligible Embolization and optimal ST resolutionRationale • TIMI-3 flow after PCI for AMI is criteria for success • But may not have myocardial perfusion due to distal embolisation • Thrombectomy can improve myocardial perfusion as assessed by ST resolution X-AMINE ST

11. Recruitment • AMI 12 hours in patients NOT receiving thrombolysis • 56% received IIb/IIIa • 200 patients, 6 month follow-up X-AMINE ST

12. Results • No difference in clinical outcomes X-AMINE ST

13. Relevance • Complementary therapy to antithrombotics in AMI • Await longer term clinical outcomes data • Useful in patients in whom antithrombotics should be kept to a minimum X-AMINE ST

14. 4. Cooling as an Adjunctive Therapy to Percutaneous Intervention in Patients with Acute Myocardial InfarctionRationale • In animal MI models, hypothermia reduces metabolic demand and infarct size • mild hypothermia inhibits platelet aggregation • test safety and efficacy of cooling (<35ºc) as adjunctive therapy to primary PCI for AMI compared to PCI alone COOL-MI

15. Recruitment • 357 patients enrolled: prospective, randomised • Acute MI < 6 h • End-point - infarct size at 30 days COOL-MI

16. Results • No difference in end-point of infarct size • Incidence of shock higher in cooling arm • Benefit in anterior MI cooled to <35ºc COOL-MI

17. Relevance • Nil (at present) • More effective rapid cooling needed (difficult in humans because of large thermal mass) • Further work in anterior MI • Beta blockers? COOL-MI

18. Thank you