Drug elution for all the case against
This presentation is the property of its rightful owner.
Sponsored Links
1 / 40

DRUG ELUTION FOR ALL? THE CASE AGAINST PowerPoint PPT Presentation


  • 85 Views
  • Uploaded on
  • Presentation posted in: General

DRUG ELUTION FOR ALL? THE CASE AGAINST. Jim McLenachan Yorkshire Heart Centre, Leeds. DRUG ELUTING STENTS. DO WE REALLY NEED THEM ? DO THEY WORK ? CAN WE SELECT “AT RISK” PATIENTS ? ARE THEY SAFE ?. Stenting and procedures for restenosis (2000 data from 40 centres).

Download Presentation

DRUG ELUTION FOR ALL? THE CASE AGAINST

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Drug elution for all the case against

DRUG ELUTION FOR ALL? THE CASE AGAINST

Jim McLenachan

Yorkshire Heart Centre,

Leeds


Drug eluting stents

DRUG ELUTING STENTS

  • DO WE REALLY NEED THEM ?

  • DO THEY WORK ?

  • CAN WE SELECT “AT RISK” PATIENTS ?

  • ARE THEY SAFE ?


Stenting and procedures for restenosis 2000 data from 40 centres

Stenting and procedures for restenosis (2000 data from 40 centres)

BCIS AUDIT


Repeat pci in ravel

REPEAT PCI IN RAVEL

Event

Free

Survival

(%)

Days after implantation

N Engl J Med 2002;346:1773-80


Cardiac events at one year ravel study

CARDIAC EVENTS AT ONE YEARRAVEL STUDY

N Engl J Med 2002;346:1773-80


Timing of events in ravel

TIMING OF EVENTS IN RAVEL

Event

Free

Survival

(%)

REPEAT

ANGIOGRAPHY

Days after implantation

N Engl J Med 2002;346:1773-80


Sirius clinical events

SIRIUS : Clinical events

Holmes et al ACC 2003


Sirius clinical events1

SIRIUS : Clinical events

Holmes et al ACC 2003


Drug eluting stents1

DRUG ELUTING STENTS

  • DO WE REALLY NEED THEM ?

  • DO THEY WORK ?

  • CAN WE SELECT “AT RISK” PATIENTS ?

  • ARE THEY SAFE ?


Drug eluting stents2

DRUG ELUTING STENTS

  • DO WE REALLY NEED THEM ?

  • DO THEY WORK ?

  • CAN WE SELECT “AT RISK” PATIENTS ?

  • ARE THEY SAFE ?


Prediction of restenosis

PREDICTION OF RESTENOSIS (%)

KEREIAKES Am J Cardiol 2000;86:336


Drug eluting stents3

DRUG ELUTING STENTS

  • DO WE REALLY NEED THEM ?

  • DO THEY WORK ?

  • CAN WE SELECT “AT RISK” PATIENTS ?

  • ARE THEY SAFE ?


Drug elution for all the case against

SCORE Trial

Binary Restenosis (%)

p<0.001 83%

Binary Restenosis (%)


Drug elution for all the case against

SCORE Trial

MACE (6 months)

SAT (%)

AMI (%)

Death (%)


Subacute thrombosis and drug eluting stents is there a link

Subacute thrombosis and drug eluting stents Is there a link?


Stent thrombosis at 56 hours

Stent thrombosis at 56 hours


Fda alert 29 th october 2002

FDA ALERT 29th October, 2002

  • FDA Advises Physicians of Adverse Events Associated with Cordis Cypher Coronary Stents

  • FDA has received more than 290 reports of thrombosis (clotting) occurring one to 30 days after the procedure to implant the device. In more than 60 of these reports, use of the device was associated with the death of the patient;

  • FDA has also received more than 50 reports, including some deaths, that Cordis considers to be possible hypersensitivity reactions.


Drug elution for all the case against

E-Sirius (male 59 yrs)

Two Cypher Stents (3.0 x 18mm + 2.5 x 18mm)

Virmani R, Guagliumi G, Farb A


Drug elution for all the case against

Marked Chronic Inflammation and Medial Destruction

Distal

Stent

Proximal

Stent

Aneurysm

Prominent eosinophils

Inflammation within and surrounding stent strutsand in adventitia


Drug elution for all the case against

Inflammatory sequelae to what?

Long Term Human Pathology: 18 Months

Eosinophils in adventitia (red colored cells, Luna stain)

Giant cells surrounding foreign material in aneurysm

Polymer coating around stent strut

Virmani R, Guagliumi G, Farb A


Long segment of lad disease

LONG SEGMENT OF LAD DISEASE


After 2 taxus stents

AFTER 2 TAXUS STENTS


4 months later

4 MONTHS LATER


Cardiac events at two years ravel study

CARDIAC EVENTS AT TWO YEARSRAVEL STUDY

MORICE et al ACC 2003


Cypher mortality from randomized trials

CYPHERMortality from Randomized trials


Drug elution for all the case against

“Selective use of drug eluting stents

can further improve the already

excellent outcome seen with

regular stent technology.”

Spencer B King III,

Circulation 2003;108:248-249


Drug elution for all the case against

“ As to diseases,

make a habit of two things –

to help, or at least do no harm.”

HIPPOCRATES


Drug elution for all the case against

“I think there is

something to this

inflammation story”

K. DAWKINS, LONDON, 5/12/03


Drug eluting stents4

DRUG ELUTING STENTS

  • DO WE REALLY NEED THEM ?

  • DO THEY WORK ?

  • CAN WE SELECT “AT RISK” PATIENTS ?

  • ARE THEY SAFE ?


Drug elution for all the case against

IAIN SIMPSON

AND

SOUTHAMPTON


Drug elution for all the case against

Dr Liam Penny

V.

Dr Alison Calver

PRIMARY PCI FOR AMI DEBATE,

BRIGHTON 24 th October. 2003


Drug elution for all the case against

SIMPO !! - 1980


Drug elution for all the case against

“In no other walk of life does the cloven hoof

so quickly display itself. Golf is the infallible test.

The man who can go into a patch of rough alone,

with the knowledge that only God is watching him,

and play his ball where it lies, is the man who will

serve you faithfully and well. But the man who is

hasty, unbalanced and violent on the links, will display

the same qualities in the wider field of everyday life.”

PG Wodehouse


  • Login