EXPEDITED REVIEWS
What is the risk of stent thrombosis associated with the use of paclitaxel-eluting stents for percutaneous coronary intervention?
A meta-analysis
Anthony A. Bavry, MD, MPH*,
Dharam J. Kumbhani, MD, SM ,
Thomas J. Helton, DO* and
Deepak L. Bhatt, MD*,*
* Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
Department of Cardiac Surgery, Veterans Administration Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Manuscript received August 3, 2004;
revised manuscript received November 11, 2004,
accepted November 29, 2004.
* Reprint requests and correspondence: Dr. Deepak L. Bhatt, Interventional Cardiology and Cardiovascular Fellowships, Cleveland Clinic Foundation, Department of Cardiovascular Medicine, 9500 Euclid Avenue, Desk F25, Cleveland, Ohio 44195
(Email: bhattd{at}ccf.org).
OBJECTIVES: This study investigated the risk of stent thrombosis associated with the use of paclitaxel-eluting stents (PES) compared to bare-metal stents (BMS).
BACKGROUND: Clinical experience with coronary drug-eluting stents (DES) is relatively limited. There is concern that DES used for percutaneous coronary intervention may result in subsequent thrombosis.
METHODS: We conducted a meta-analysis on eight trials (total of 13 study arms) in 3,817 patients with coronary artery disease who were randomized to either PES or BMS.
RESULTS: As compared with BMS, PES do not increase the hazard for thrombosis up to 12 months (risk ratio [RR] = 1.06, 95% confidence interval [CI] 0.55 to 2.04, p = 0.86]). There was no evidence of heterogeneity among the studies (chi-square value for Q-statistic = 5.90 [10 degrees of freedom], p = 0.82). Similar results were obtained when the analysis was restricted to trials with a polymeric stent platform (Treatment of de novo coronary disease using a single pAclitaXel elUting Stent [TAXUS]-I, -II, -IV, and -VI) (RR = 1.01, 95% CI 0.40 to 2.53, p = 0.99), trials with longer lesions (TAXUS-IV and -VI) (RR = 0.62, 95% CI 0.2 to 1.91, p = 0.41), and trials that used a higher dose of paclitaxel (ASian Paclitaxel-Eluting Stent Clinical trial [ASPECT], European evaLUaTion of paclitaxel Eluting Stents [ELUTES], and DELIVER-I) (RR = 1.87, 95% CI 0.52 to 6.81, p = 0.34).
CONCLUSIONS: Current evidence suggests that standard dose PES do not increase the hazard of stent thrombosis compared to BMS.
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Abbreviations and Acronyms
| | BMS = bare-metal stents | | CI = confidence interval | | DES = drug-eluting stents | | PCI = percutaneous coronary intervention | | PES = paclitaxel-eluting stents | | RR = risk ratio |
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107(2):
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117(16):
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|
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|
|
|
|
|
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|
|
|
|
|
|
|
R Hoffmann, M-C Morice, J W Moses, P J Fitzgerald, L Mauri, G Breithardt, J Schofer, P W Serruys, H-P Stoll, and M B Leon
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|
|
|
|
|
|
|
K. E. Kip, K. Hollabaugh, O. C. Marroquin, and D. O. Williams
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February 19, 2008;
51(7):
701 - 707.
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|
|
|
|
|
|
|
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358(4):
331 - 341.
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|
|
|
|
|
|
|
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28(21):
2578 - 2582.
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|
|
|
|
|
|
|
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116(17):
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|
|
|
|
|
|
|
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July 10, 2007;
50(2):
119 - 127.
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|
|
|
|
|
|
|
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July 10, 2007;
50(2):
109 - 118.
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[PDF]
|
|
|
|
|
|
|
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115(22):
2842 - 2847.
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|
|
|
|
|
|
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B. Lagerqvist, S. K. James, U. Stenestrand, J. Lindback, T. Nilsson, L. Wallentin, and the SCAAR Study Group
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356(10):
1009 - 1019.
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|
|
|
|
|
|
|
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28(6):
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|
|
|
|
|
|
|
T. F. Luscher, J. Steffel, F. R. Eberli, M. Joner, G. Nakazawa, F. C. Tanner, and R. Virmani
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February 27, 2007;
115(8):
1051 - 1058.
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|
|
|
|
|
|
|
J. A.S. Muldowney III, J. R. Stringham, S. E. Levy, L. A. Gleaves, M. Eren, R. N. Piana, and D. E. Vaughan
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|
|
|
|
|
|
|
E. C. Keeley and L. D. Hillis
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356(1):
47 - 54.
[Full Text]
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|
|
|
|
|
|
|
M. Pfisterer, H. P. Brunner-La Rocca, P. T. Buser, P. Rickenbacher, P. Hunziker, C. Mueller, R. Jeger, F. Bader, S. Osswald, C. Kaiser, et al.
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48(12):
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|
|
|
|
|
|
|
A H Gershlick and G Richardson
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December 16, 2006;
333(7581):
1233 - 1234.
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|
|
|
|
|
|
|
W. Desmet
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Eur. Heart J.,
September 2, 2006;
27(18):
2147 - 2149.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Spertus, R. Kettelkamp, C. Vance, C. Decker, P. G. Jones, J. S. Rumsfeld, J. C. Messenger, S. Khanal, E. D. Peterson, R. G. Bach, et al.
Prevalence, Predictors, and Outcomes of Premature Discontinuation of Thienopyridine Therapy After Drug-Eluting Stent Placement: Results From the PREMIER Registry
Circulation,
June 20, 2006;
113(24):
2803 - 2809.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol.,
April 18, 2006;
47(8):
1689 - 1706.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. P. Kappetein, K. D. Dawkins, F. W. Mohr, M. C. Morice, M. J. Mack, M. E. Russell, J. Pomar, and P. W.J.C. Serruys
Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease. Insights from the SYNTAX run-in phase.
Eur. J. Cardiothorac. Surg.,
April 1, 2006;
29(4):
486 - 491.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. G. Raja
Drug-Eluting Stents and the Future of Coronary Artery Bypass Surgery: Facts and Fiction
Ann. Thorac. Surg.,
March 1, 2006;
81(3):
1162 - 1171.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. K. Kuchulakanti, W. W. Chu, R. Torguson, P. Ohlmann, S.-W. Rha, L. C. Clavijo, S.-W. Kim, A. Bui, N. Gevorkian, Z. Xue, et al.
Correlates and Long-Term Outcomes of Angiographically Proven Stent Thrombosis With Sirolimus- and Paclitaxel-Eluting Stents
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February 28, 2006;
113(8):
1108 - 1113.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Brener
Wish List and REALITY: Choice of Stents and End Points for Treatment of De Novo Coronary Artery Lesions
JAMA,
February 22, 2006;
295(8):
937 - 938.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Kelbaek, L. Thuesen, S. Helqvist, L. Klovgaard, E. Jorgensen, S. Aljabbari, K. Saunamaki, L. R. Krusell, G. V.H. Jensen, H. E. Botker, et al.
The Stenting Coronary Arteries in Non-stress/benestent Disease (SCANDSTENT) Trial
J. Am. Coll. Cardiol.,
January 17, 2006;
47(2):
449 - 455.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, D. Sahn, and S. Tsimikas
Highlights of the Year in JACC 2005
J. Am. Coll. Cardiol.,
January 3, 2006;
47(1):
184 - 202.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Kelbaek, L. Thuesen, S. Helqvist, L. Klovgaard, E. Jorgensen, S. Aljabbari, K. Saunamaki, L. R. Krusell, G. V.H. Jensen, H. E. Botker, et al.
The Stenting Coronary Arteries in Non-stress/benestent Disease (SCANDSTENT) Trial
J. Am. Coll. Cardiol.,
December 13, 2005;
(2005)
j.jacc.2005.10.045v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. L. Bhatt
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JAMA,
June 15, 2005;
293(23):
2935 - 2937.
[Full Text]
[PDF]
|
|
|
|
