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Dr. G. Raveendran Presentation on Interventional Cardiology
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GaneshRaveendran,M.D.,M.S.
Director;SectionofInterventionalCardiology
&CardiovascularFellowshipProgram
UniversityofMinnesotaMedicalSchool
AdvancesinInterventionalCardiology
• Thefirstballoonangioplastywas
performedbyAndreasGrüntzigin1977
• Atfirst,PTCAwaslimitedtopatients
withadiscrete,proximal,concentric
andnon‐calcificlesioninasinglemajor
coronaryarterywithnoinvolvementof
majorsidebranchesorangulations
AndreasGrüntzig
AnrdeasGrüntzig,1939‐1985
LandmarkTrialsEarlyBMSStudies
STRESSn=410 BENESTENTn=520
PSerruysetal.,NEnglJMed1994
mm P<.001
DLFishmanetal.,NEnglJMed1994
P<.001 p=0.01 mm P<.001 P<.001 p=0.09
PTCAstent
In-stent Restenosis
SIRIUS:AngiographicandClinicalEndpoints
Sirolimus Stent
Bare Stent
91% reduction
p<0.001
Sirolimus Stent
Bare Stent
MACE
p<0.001
TVF=cardiacdeath,MI,orischemia‐drivenTVR
TVF(%)
Months
10.7%
15.4%
2‐yearHR0.68[0.48,0.98]
P=0.04
Δ4.7%10.8%
8.3%
1‐yearHR0.73[0.48,1.10]
P=0.13
Δ2.5%
0%
5%
10%
15%
20%
0 3 6 9 12 15 18 21 24
XIENCEVTAXUS
FullyBiodegradableStentPlatforms
1996
VanderGiessenCirculation
Animalstudiespolymericscaffoldsrevealingexcessive
inflammatoryreactions
IgakiTamaiFirstfullybiodegradablenondrugelutingscaffold
N=15
TamaiCirculation
Bioresorbablevascularscaffold
firstbioabsorbabledrugelutingscaffold
N=31
OrmistonLancet
AMS‐1firstbioabsorbablemetallicnondrug‐elutingscaffold
N=64
ErbelLancet
2000 2007 2008
JabaraPCR2009
2009
REVAPolycarbonatestent,radiopaque,nondrug‐
elutingscaffoldN=31
IDEALBDSPolyanhidride
esterandsalicylicacid,drug‐elutingscaffold
N=11
AbizaidTCT2009
DREAMSfirstdrug‐elutingbioabsorbablemetallicscaffold
N=22
HaudePCR2011
2011
FrequencyofCardiogenicShock
1Babaev A et al : JAMA 2005; 294:444-454 2Goldberg RJ NEJM 1991; 325:1117 3 Holmes DR JACC 1995 26:668
Total Shock
Clinical Event
Shock at Presentation
Worcester Heart Attack Study2 : 1975-88 7.5%
Gusto-13: 1995 7.2%
NRMI Registry1: N=293,633 NRMI STEMI Registry N=25,311
Jan 1995-May 2004
STEMI or new LBBB
775 US Hospitals with on-site PCI
CS developed in 25,311 (8.6%) pts,
CS present on admission in 2.9%
IPTCA
Theevolution….
Do#erDCA,ROTAand
adjunc3vedevices PSstent IGenera(onDES
NewBMSstents
1965 2002‐…
whatnext?
IIGenera(onDES
TheEvolu3onofInterven3onalCardiology……
1977 ’90s‘80s
PercutaneousTranscatheterImplantationofanAorticValveProsthesisforCalcificAorticStenosisFirstHumanCaseDescription
AlainCribier,MD;HeleneEltchaninoff,MD;AssafBash,PhD;NicolasBorenstein,MD;ChristopheTron,MD;FabriceBauer,MD;GenevieveDerumeaux,MD;FredericAnselme,MD;FrançoisLaborde,MD;MartinB.Leon,MD
Adopted from TCT presentation: Dr. Leon
Source:BIBAMedical,UK‐basedproviderofmarketanalysisforthemedicaldeviceindustry
2010 2011
MarketShareAcrossEUCountries
Germany
FranceItaly
UK
Spain
Netherlands
Switzerland
Others
Germany
France
Italy
UK
Spain
Netherlands
Switzerland
Austria
Others
0%
20%
40%
60%
80%
100%
0 6 12 18 24
PrimaryEndpoint:AllCauseMortality
Allcausemortality
HR[95%CI]=0.51[0.38,0.68]
p(logrank)<0.001
∆at1yr=20.0%NNT=5.0pts
50.7%
30.7%
179179
TAVRStdTxNumbersatRisk
138121
12485
10356
6024
Months
TAVR
StdTx
0
0.1
0.2
0.3
0.4
0.5
0 6 12 18 24
TAVR AVR
Months
348 298 260 147 67
351 252 236 139 65
No.atRisk
TAVR
AVR
26.8
24.2
HR[95%CI]=0.93[0.71,1.22]P(logrank)=
0.62
CurrentTAVREligibilityAccordingToOperativeRisk
Reasonable
Adapted from S. Kodali
Low or Moderate High Inoperable
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