Giuseppe Biondi Zoccai Division of Cardiology University of Turin, Turin Critical aspects of trials on the new generation DES 31st.

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Presentation transcript:

Giuseppe Biondi Zoccai Division of Cardiology University of Turin, Turin Critical aspects of trials on the new generation DES 31st Congress of the Italian Society of Invasive Cardiology – 20 October 2010

Learning goals Why do we need new generation DES? Issues with trials of new-generation DES What does the future hold?

Drawbacks of 1st generation DES: low deliverability deliverability Schmidt et al, Catheter Cardiovasc Interv 2009

Drawbacks of 1st generation DES: late restenosis Cosgrave et al, Am J Cardiol 2007

Drawbacks of 1st generation DES: late thrombosis Stent thrombosis Lagerqvist et al, Circ Cardiovasc Intervent 2009

Learning goals Why do we need new generation DES? Issues with trials of new-generation DES What does the future hold?

BioMatrix Serruys, TCT 2010

Endeavor Resolute Silber, TCT 2010

NEVO Mauri, TCT 2010

Nobori Chevalier, TCT 2010

Yukon *polymer-free, rapamycin/probucol-eluting stent; †Endeavor Resolute; Mehilli, TCT 2010 * †

Promus/Xience SPIRIT/COMPARE meta-analysis – N=6789 – 1-year MACE Stone, TCT 2010

Promus/Xience SPIRIT/COMPARE meta-analysis – N=6789 – 1-year MACE Stone, TCT 2010

TAXUS Element Kereiakes et al, J Am Coll Cardiol 2010

TAXUS Element Kereiakes et al, J Am Coll Cardiol 2010

PROMUS Element

Learning goals Why do we need new generation DES? Issues with trials of new-generation DES What does the future hold?

A glimpse into the future Bioabsorbable platforms Polymer-free stents Anti-hyperplasia & pro-healing cocktails

A glimpse into the future Bioabsorbable platforms Polymer-free stents Anti-hyperplasia & pro-healing cocktails

Take home messages Wijns et al, EHJ 2010

Take home messages Despite their superiority versus BMS, 1st generation DES has several drawbacks As several 2nd generation DES are there, device choice should be individualized based on evidence (especially long-term follow-up data), patient and lesion features Further improvements can be envisioned, but 3rd generation DES will still need to be scientifically tested in rigorous trials with long- term follow-up

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