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Francesco Burzotta

OPTIMIST: the Outcome of Pci for stent-ThrombosIs MultIcentre STudy. Francesco Burzotta. Institute of Cardiology, Policlinico A. Gemelli – Catholic University of the Sacred Heart (UCSC). HOTLINE III, ESC Congress 2007 September 4th 2007, Vienna. BACKGROUND AND RATIONALE FOR THE STUDY.

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Francesco Burzotta

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  1. OPTIMIST: the Outcome of Pci for stent-ThrombosIs MultIcentre STudy Francesco Burzotta Institute of Cardiology, Policlinico A. Gemelli –Catholic University of the Sacred Heart (UCSC) HOTLINE III, ESC Congress 2007September 4th 2007, Vienna

  2. BACKGROUND AND RATIONALE FOR THE STUDY Stent thrombosis occurs in 1-2% of the pts treated by PCI with stent implantation Usage of drug-eluting stents (DES) in the real world practice might increase risk of stent thrombosis compared to bare metal stents (BMS) The most common management of pts with stent thrombosis is re-PCI There is lack of scientific data describing the angiographic and clinical outcome of PCI for stent thrombosis in the contemporary DES era

  3. AIMS OF THE OPTIMIST STUDY TO COMPARE THE CLINICAL AND ANGIOGRAPHIC CHARACTERISTICS OF DES VS BMS THROMBOSIS TO ASSESS THE CLINICAL OUTCOME OF PCI FOR STENT THROMBOSIS TO EVALUATE THE EFFICACY OF THROMBECTOMY DEVICES DURING PCI FOR STENT THROMBOSIS

  4. Pol. Gemelli (Prof. Crea, Dr Trani, Dr Romagnoli) S.Pietro FBF (Dr Belloni) S.Filippo Neri (Dr Pristipino) S.Carlo (Dr Mazzarotto) S.Giovanni (Dr. Manzoli) S.Camillo (Dr Parma) S.Spirito (Dr Danesi) S.Eugenio (Dr Gioffrè) Pol. Umberto I (Dr Sardella) Pertini (Dr Rigattieri) Pol. Casilino (Dr Summaria) THE OPTIMIST STUDY DESIGN Non sponsored, multicentre registry

  5. THE OPTIMIST STUDY DESIGN Non sponsored, multicentre registry Enrolling during two years (2005-2006) all patients undergoing urgent PCI for angiographically-confirmed stent thrombosis TO ASSESS: The clinical outcome @ 30-day and @ 6-month (primary endpoints: death and MACCE) The angiographic outcome of PCI by an independent core-lab: Rome Heart Research, Dr Prati (primary end-points: TIMI 3+MBG 2-3 and MBG 3) Burzotta et al, Am Heart J 2007

  6. RESULTS PREVALENCE OF PCI FOR STENT THROMBOSIS

  7. 2484* urgent (primary or rescue) PCI for STEMI 89 (74%) STEMI UA NSTEMI = = = 1.05% 0.85% 3.6% PREVALENCE OF PCI FOR STENT THROMBOSIS OPTIMIST centres 12280* PCI with stenting 4962* PCI with BMS (40.4%) 7318* PCI with DES (59.6%) 52 PCI for BMS thrombosis 62 PCI for DES thrombosis P=0.24 120 PCI for stent thrombosis in 110 patients *Official data of the Italian Society of Interventional Cardiology SICI-GISE

  8. CHARACTERISTICS OF THE STUDY POPULATION

  9. RESULTS DES vs BMS THROMBOSIS

  10. DES VS BMS: BASELINE CHARACTERISTICS

  11. DES VS BMS: BASELINE CHARACTERISTICS

  12. % DES BMS 0-24 hrs 1-30 days 31-365 days > 1 year ACUTE SUBACUTE LATE VERY LATE DES VS BMS: TYPES OF THROMBOSIS

  13. DES VS BMS: TYPES OF THROMBOSIS P=0.03 % DES BMS <30 days > 30 days ACUTE or SUBACUTE LATE or VERY LATE

  14. RESULTS OUTCOME OF PCI FOR STENT THROMBOSIS

  15. PROCEDURAL CHARACTERISTICS

  16. PCI FOR STENT THROMBOSIS: CLINICAL OUTCOME

  17. % 100 80 60 40 20 0 1 mo. 6 mo. 12 mo. DES VS BMS: OUTCOME AFTER THROMBOSIS DES BMS no death no MACCE

  18. 10.0 (1.2-85.7) VERY LATE THROMBOSIS 5.4 (1.3-22.8) OTHER IMPLANTED STENT DURING PCI 0.3 (0.1-0.9) POST-PCI MBG 2-3 1 2 3 4 5 6 7 8 9 10 11 0 increased mortality PREDICTORS OF OUTCOME IN PCI FOR STENT THROMBOSIS OR (95%CI) for 6-month mortality in MULTIVARIATE analysis

  19. RESULTS THROMBECTOMY DURING PCI FOR STENT THROMBOSIS

  20. BY INTENTION TO TREAT STANDARD PCI in 83 pts (75%) THROMBECTOMY in 27 PTS (25%) Angiojet(7,5%) pre-PCI risk features Export(44.4%) > STEMI > Longer time-to-treatment > Inotropic drugs pre-PCI > Females Diver CE(48.1%) > Large vessels PCI FOR STENT THROMBOSIS: USE OF THROMBECTOMY Selection of devices according to the operator’s preference

  21. TIMI 3 + MBG 2/3 MBG 3 % 76% 61% 52% 46% % Pts without Shock (n=81) P=0.027 P=0.18 89% 61% 61% 46% ANGIOGRAPHIC RESULTS OF THROMBECTOMY Thrombectomy Standard PCI

  22. CONCLUSIONS In the contemporary DES era… 1. Urgent PCI is needed for both DES and BMS thrombosis and represents 3.6% of the urgent PCI for STEMI 2. PCI for stent thrombosis is associated with a high rate of major adverse events, especially in pts with very late thrombosis 3. DES thrombosis, compared to BMS, shows different clinical features (late or very late presentation, association with anti-PLT therapy withdrawal) but similar long term outcome 4. During PCI for stent thrombosis, implantation of other stents should be avoided. Mechanical thrombectomy is feasible and should be reserved to pts without haemodynamic instability

  23. Thank you for your attention

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