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Treatment of higher-risk patients with an indication for revascularization: evolution within the field of contemporary percutaneous coronary intervention Rotational Atherectomy Followed by Drug-Coated Balloon Dilation for Left Main In-Stent Restenosis in the Setting of Acute Coronary Syndrome Complicated with Right Coronary Chronic Total Occlusion Acute Noncardiac Organ Failure in Acute Myocardial Infarction With Cardiogenic Shock ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: A Report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography Single-Molecule hsTnI and Short-Term Risk in Stable Patients With Chest Pain Clinician’s Guide to Reducing Inflammation to Reduce Atherothrombotic Risk Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus Predicting Major Adverse Events in Patients With Acute Myocardial Infarction
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CIT2019 - 最新临床研究亮点

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CIT2019 - Research Spotlights
高危出血患者PCI治疗策略
LEADERS FREE Ⅱ Trail - 现有指南推荐非出血高风险的ACS患者接受PCI治疗后DAPT治疗时间持续12个月。高出血风险患者接受置入DES支架的PCI治疗后，可考虑将P2Y12抑制剂治疗缩短至 3～6个月（Ⅱb类推荐）。

2016年德国埃森大学医院Christoph K. Naber教授曾在EuroPCR上汇报了置入二代DES BioFreedom BA9药物涂层支架（Drug Coated Stent，DCS）介入治疗后进行1个月DAPT治疗相较于金属支架的有效性及安全性。
Biolimus-A9 polymer-free coated stent in high bleeding risk patients with acute coronary syndrome: a Leaders Free ACS sub-study
http://www.cbsmd.org/CBS2017CMS/scientificresearch.php?cid=127&id=1998&oldpage=1&ordertype=hits&page=1

LEADERS FREE研究对高出血风险因子的界定：
1) 年龄≥75岁；
2) PCI术后接受口服抗凝药物；
3) 无法耐受＞30天的DAPT治疗;
4. 重要的手术相关指标包括长病变和复杂病变（即B2 & C型病变）。

预告CIT2019大会上，Naber教授将进一步汇报LEADERS FREE Ⅱ研究评估高出血风险患者药物涂层支架置入术后进行1个月DAPT的临床预后结果。
 
影像学指导PCI
ULTIMATE Trail - 在经诊断为无症状缺血、稳定或不稳定心绞痛或>24小时因胸痛入院的心肌梗死（包含STEMTI和NSTEMTI）的符合药物洗脱支架置入条件的全患者中证实了在理想药物洗脱支架置入的血管内超声（IVUS）指导下的DES置入相较于冠脉造影指导来说，不仅可辅助术者更准确地评估斑块内纤维、纤维脂质混合、坏死核和钙化等四种组织，优化置入效果，还可最终改善简单病变、甚至复杂病变PCI患者的预后。

理想的药物洗脱支架置入的IVUS标准，即：
1）DES植入后支架段最小管腔面积>5.0mm2，或大于90%的远端参考血管的最小管腔面积；
2）支架近端或远端5mm内的最大斑块负荷<50%;
3）无深达中层且存在长度超过3mm的夹层。

"Intravascular Ultrasound-Guided Versus Angiography-Guided Implantation of Drug-Eluting Stent in All-Comers: The ULTIMATE trial"
http://www.cbsmd.org/CBS2017CMS/scientificresearch.php?cid=112&id=1254&oldpage=1&ordertype=posttime&page=1

"CBSMD专访——ULTIMATE研究者张俊杰谈IVUS之过去、现在和未来"
http://www.cbsmd.org/CBS2017CMS/newsshow.php?cid=4&id=1620

预告本届CIT2019大会上，张俊杰教授将进一步汇报ULTIMATE Trail亚组分析及荟萃分析结果。
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