New generation DES: which role in ACS?

1. New generation DES: which role in ACS? Giuseppe Biondi Zoccai, MD Division of Cardiology University of Modena and Reggio Emilia gbiondizoccai@gmail.com Emergenzecardiologichee morte improvvisa: percorsi assistenziali Sala A - 08:45-09:00 - 1 Aprile 2011 - Pala De Andrè - VialeEuropa 1, Ravenna

2. DES in ACS C’mon, c’mon - it’s either one or the other

3. LEARNING GOALS • Scope of the problem • Old generation DES • New generation DES • BES • EES • ZES I • ZES II

4. LEARNING GOALS • Scope of the problem • Old generation DES • New generation DES • BES • EES • ZES I • ZES II

5. INCIDENCE OF DES THROMBOSIS very late total acute subacute late D’Ascenzo et al, submitted

6. PREDICTORS OF STENT THROMBOSIS D’Ascenzo et al, submitted

7. PREDICTORS OF STENT THROMBOSIS 9 D’Ascenzo et al, submitted

8. LEARNING GOALS • Scope of the problem • Old generation DES • New generation DES • BES • EES • ZES I • ZES II

9. SES

10. PES

14. LEARNING GOALS • Scope of the problem • Old generation DES • New generation DES • BES • EES • ZES I • ZES II

15. WHEN LESS IS MORE?

16. LEARNING GOALS • Scope of the problem • Old generation DES • New generation DES • BES • EES • ZES I • ZES II

17. LEADERS TRIAL

18. LEADERS TRIAL

21. LEARNING GOALS • Scope of the problem • Old generation DES • New generation DES • BES • EES • ZES I • ZES II

22. COMPARE TRIAL

23. COMPARE TRIAL Primaryend-point of death, MI or TVR

24. COMPARE TRIAL Definite or probable stent thrombosis

30. LEARNING GOALS • Scope of the problem • Old generation DES • New generation DES • BES • EES • ZES I • ZES II

31. SORT OUT III TRIAL

32. SORT OUT III TRIAL

33. LEARNING GOALS • Scope of the problem • Old generation DES • New generation DES • BES • EES • ZES I • ZES II

34. RESOLUTE ALL COMERS

35. RESOLUTE ALL COMERS * *Targetlesionfailure

36. RESOLUTE ALL COMERS

37. RESOLUTE ALL COMERS

38. TAKE HOME MESSAGES

39. TAKE HOME MESSAGES • First generation DES have been proven safe and effective in patients with ACS who can comply with at least 6-12 months of DAT • New generation DES hold the promise of further clinical benefits in ACS, even if dedicated trials are lacking • BES and EES appear particularly promising in this setting, albeit only at post-hoc analyses

40. ABSTRACT Compared with medical therapy, percutaneous coronary intervention has been shown to reduce the rates of death and recurrent ischemia in patients presenting with acute coronary syndromes (ACS). In the current interventional era, first generation as well as second generation drug-eluting stents (DES) and bare-metal stents (BMS) have been widely used, despite the fact that the use of DES in the context of ACS was initially an “off-label” indication and that ACS has been associated with stent thrombosis (ST). In contrast to the wealth of data available for the use of DES in patients with ST-elevation myocardial infarction, data regarding the performance of DES in non–ST-elevation ACS is restricted to a handful of registries with conflicting data. The aim of this presentation is to summarize the safety and efficacy of DES in the entire spectrum of ACS, with specific emphasis on new generation DES.

41. For these and further slides on these topics please feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html