RESEARCH, REDUCE III, X-AMINE ST, COOL-MI

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RESEARCH, REDUCE III, X-AMINE ST, COOL-MI

• Azfar Zaman
• Freeman Hospital, Newcastle

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1. Rapamycin Eluting Stent Evaluated At Rotterdam
Cardiology Hospital Rationale

• Sirolimus eluting stents reduce restenosis and
  reintervention
• Increased risk of early and late stent thrombosis
  
• Are SES safe and effective in a thrombogenic
  environment post STEMI?

RESEARCH
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Recruitment

• 96 patients with STEMI enrolled as part of
  registry of SES implantation in Rotterdam
• ACTgt300 (200-250 with IIb/IIIa)
• Clopidogrel between 3-6 months

RESEARCH
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Results

• MACE (death, nonfatal MI, reintervention) 6 m
  angiogram
• mean age 57y, IIb/IIIa in 46.9
• ref. diameter 2.73 0.59, length 16.9 9.95 mm
• No early or late stent thromboses
• No reinterventions and no restenosis

RESEARCH
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Relevance

• Single centre registry data but unrestricted
• NICE (DES gt15mm/lt3mm) except if MI in preceding
  24h or evidence of thrombus
• Supporting evidence for safe use (of sirolimus)
  in MI need larger studies

RESEARCH
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2. Restenosis Reduction by Cutting Balloon
Evaluation III Rationale

• Failure of CB to reduce angiographic or clinical
  outcomes in ISR (versus standard balloon)
• Can predilation with CB versus standard balloon
  before bare metal stent deployment reduce
  restenosis ?

REDUCE III
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Recruitment

• Randomised, multicentre (Japan)
• 521 patients
• Mean age 65 years

REDUCE III
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Results
REDUCE III
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Relevance

• A role for cutting balloonat last?
• DES for NICE lesions, CB plus BMS for others
• Promising.2 years too late?

REDUCE III
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3. X-Sizer in AMI patients for Negligible
Embolization and optimal ST resolution Rationale

• TIMI-3 flow after PCI for AMI is criteria for
  success
• But may not have myocardial perfusion due to
  distal embolisation
• Thrombectomy can improve myocardial perfusion as
  assessed by ST resolution

X-AMINE ST
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Recruitment

• AMI? 12 hours in patients NOT receiving
• thrombolysis
• 56 received IIb/IIIa
• 200 patients, 6 month follow-up

X-AMINE ST
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Results

• No difference in clinical outcomes

X-AMINE ST
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Relevance

• Complementary therapy to antithrombotics in AMI
• Await longer term clinical outcomes data
• Useful in patients in whom antithrombotics should
  be kept to a minimum

X-AMINE ST
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4. Cooling as an Adjunctive Therapy to
Percutaneous Intervention in Patients with Acute
Myocardial InfarctionRationale

• In animal MI models, hypothermia reduces
  metabolic demand and infarct size
• mild hypothermia inhibits platelet aggregation
• test safety and efficacy of cooling (lt35ºc) as
  adjunctive therapy to primary PCI for AMI
  compared to PCI alone

COOL-MI
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Recruitment

• 357 patients enrolled prospective, randomised
• Acute MI lt 6 h
• End-point - infarct size at 30 days

COOL-MI
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Results

• No difference in end-point of infarct size
• Incidence of shock higher in cooling arm
• Benefit in anterior MI cooled to lt35ºc

COOL-MI
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Relevance

• Nil (at present)
• More effective rapid cooling needed
• (difficult in humans because of large thermal
  mass)
• Further work in anterior MI
• Beta blockers?

COOL-MI
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Thank you