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

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

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

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

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

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

7. BioMatrix Serruys, TCT 2010

8. Endeavor Resolute Silber, TCT 2010

9. NEVO Mauri, TCT 2010

10. Nobori Chevalier, TCT 2010

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

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

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

14. TAXUS Element Kereiakes et al, J Am Coll Cardiol 2010

15. TAXUS Element Kereiakes et al, J Am Coll Cardiol 2010

16. PROMUS Element

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

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

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

22. Take home messages Wijns et al, EHJ 2010

23. 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

24. Thank you for your attention For any correspondence: gbiondizoccai@gmail.com For these and further slides on these topics feel free to visit the metcardio.org website: http://www.metcardio.org/slides.html gbiondizoccai@gmail.com http://www.metcardio.org/slides.html