【導讀】XIENCEDAPT中斷/停用數(shù)據(jù)。不同DES的安全性表現(xiàn)。臨床使用DAPT的難題。支架血栓大型薈萃分析。SPIRIT-COMPARE永久性DAPT停用薈萃分析。真實世界DAPT中斷研究

　　

【正文】 Abbott. All rights reserved. AP2936456OUS Rev. B. 31 0 . 00 . 51 . 01 . 52 . 0X I E N C E V M U L T I L I N K V I S I O NIncidence of ARC Def ST (%)p= % % n=751 Sources: 1M. Sabate, EXAMINATION 1Year Presentation. ESC 2020. 2W. Wijns. EXAMINATION Discussant Presentation. ESC 2020. Investigator Sponsored Study 1年 ARC 定義確定的支架血栓 1 n=747 “醫(yī)生通過使用新型的 DES，尤其是這個特定品牌的 DES，可以減少在 STEMI患者中使用 DES時對早期安全性的擔憂 .” – Dr. William Wijns EXAMINATION Discussant, ESC 20202 74% 降低 EXAMINATION 研究 XIENCE的安全性優(yōu)于 BMS Information contained herein is for Europe, Middle East and Africa, and Asia Pacific only, and not intended for physicians from France, Japan or the United States. 169。2020 Abbott. All rights reserved. AP2936456OUS Rev. B. 32 Source: M. Sabate, EXAMINATION 1Year Presentation. ESC 2020. Investigator Sponsored Study XIENCE V n=751 MULTILINK VISION n=747 % % p= ARC定義確定的 /可能的支架血栓 1年 ARC定義確定的/可能的支架血栓發(fā)生率 (%) 0 XIENCE V 急性 亞急性 晚期 MULTILINK VISION 急性 亞急性 晚期 The cumulative ST rates are based on KaplanMeier estimates. EXAMINATION 研究 XIENCE的安全性優(yōu)于 BMS Information contained herein is for Europe, Middle East and Africa, and Asia Pacific only, and not intended for physicians from France, Japan or the United States. 169。2020 Abbott. All rights reserved. AP2936456OUS Rev. B. 33 支架血栓網(wǎng)絡薈萃分析 XIENCE是市場上最安全的支架 “目前 發(fā)現(xiàn) CoCrEES (XIENCE)較 BMS有更低的支架血栓 發(fā) 生率，如果在將來的研究中得到 進 一步 證實 ，將會 帶 來治 療 模式的巨大 轉(zhuǎn)變 ?！? “有些人 認為類 似于裸支架的 產(chǎn) 品 應該 具有更低的支架血栓 發(fā) 生率，并基于此假 設 致力于可吸收涂 層 支架的研 發(fā) 。這 個研究 帶 來的 發(fā)現(xiàn) 可能會 讓這 些人停下來。” 2 Source: 1Palmerini et al. The Lancet. March 23, 2020 DOI:(12)603249 2Ormiston. The Lancet, March 23, 2020 DOI:(12)604401 Information contained herein is for Europe, Middle East and Africa, and Asia Pacific only, and not intended for physicians from France, Japan or the United States. 169。2020 Abbott. All rights reserved. AP2936456OUS Rev. B. 35 1 and 2 Year Definite Stent Thrombosis Rate Pooled Odds Ratio* Palmerini et al. The Lancet. March 23, 2020 DOI:(12)603249 * An odds ratio is a method of paring whether the probability of an event is the same between two groups Xience支架血栓發(fā)生率顯著低于所有對照產(chǎn)品 支架血栓網(wǎng)絡薈萃分析 XIENCE是唯一一個術后 2年支架血栓發(fā)生率低于 BMS的 DES Information contained herein is for Europe, Middle East and Africa, and Asia Pacific only, and not intended for physicians from France, Japan or the United States. 169。2020 Abbott. All rights reserved. AP2936456OUS Rev. B. 36 Palmerini et al. The Lancet. March 23, 2020 DOI:(12)603249 與 XIENCE相比支架血栓 風險 成倍增加 一年支架血栓發(fā)生率比值比 支架血栓網(wǎng)絡薈萃分析 XIENCE是市場上最安全的支架 XIENCE ST Risk XIENCE Information contained herein is for Europe, Middle East and Africa, and Asia Pacific only, and not intended for physicians from France, Japan or the United States. 169。2020 Abbott. All rights reserved. AP2936456OUS Rev. B. 37 在真實世界研究中，持續(xù)一致的低支架血栓發(fā)生率 COMPARE II1 (n=1,670) vs. Nobori RESOLUTE All Comers2 (n=2,292) vs. Endeavor Resolute SPIRIT IV4 (n=3,687) vs. Taxus SORT OUT3 (n=2,774) vs. Cypher LESSON6 (n=2,684) vs. Cypher COMPARE7 (n=1,800) vs. Taxus RESOLUTE All Comers5 (n=2,292) vs. Endeavor Resolute % % % % % % % % % % % % % % p= p= p= p= p= p= p= XIENCE Competitor ARC 確定的支架血栓 (%) Source: 1. Smits, PCR 2020. , PCR 2020. , TCT 2020. 4. Stone, TCT 2020. , PCR 2020. , ESC 2020. , TCT 2020. Results from clinical trials are not directly parable. Information provided for educational purposes. Information contained herein is for Europe, Middle East and Africa, and Asia Pacific only, and not intended for physicians from France, Japan or the United States. 169。2020 Abbott. All rights reserved. AP2936456OUS Rev. B. 38 結(jié)論 ? XIENCE支架具有出色的安全性表現(xiàn)，并獲得 CE批準，最少使用 3個月 DAPT ? 對于臨床工作而言，常規(guī)選擇具有最佳安全性的 DES將為患者帶來更好的治療 ? 對于一些具有潛在 DAPT停用風險的患者，如決定選用 DES應優(yōu)先考慮具有短 DAPT適應癥的藥物洗脫支架