EXPEDITED REVIEWS
Drug-eluting stent thrombosis
Results from a pooled analysis including 10 randomized studies
Raúl Moreno, MD, FESC*,
Cristina Fernández, MD,
Rosana Hernández, MD, FESC,
Fernando Alfonso, MD, FESC,
Dominick J. Angiolillo, MD,
Manel Sabaté, MD, FESC,
Javier Escaned, MD, FESC,
Camino Bañuelos, MD, FESC,
Antonio Fernández-Ortiz, MD, FESC and
Carlos Macaya, MD, FESC
Division of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
Manuscript received September 2, 2004;
revised manuscript received October 29, 2004,
accepted November 2, 2004.
* Reprint requests and correspondence: Dr. Raúl Moreno, Division of Interventional Cardiology, Hospital Clinico San Carlos, Martín Lagos, s/n. 28040 Madrid, Spain
(Email: raulmorenog{at}terra.es).
This work was presented in part at the 77th Annual Scientific Sessions of the American Heart Association, New Orleans, Louisiana, November 2004.
OBJECTIVES: We compared the risk of stent thrombosis (ST) after drug-eluting stents (DES) versus bare-metal stents (BMS), and tested the hypothesis that the risk of DES thrombosis is related to stent length.
BACKGROUND: Whether DES increase the risk of ST remains unclear. Given the very low restenosis rate after drug-eluting stenting, longer stents are frequently implanted for the same lesion length in comparison to BMS.
METHODS: We included in a meta-analysis 10 randomized studies comparing DES and BMS. Overall, 5,030 patients were included (2,602 were allocated to DES and 2,428 to BMS). The risk of thrombosis after DES versus BMS was compared, and the relationship between the rate of DES thrombosis and stent length was evaluated.
RESULTS: Incidence of ST was not increased in patients receiving DES (0.58% vs. 0.54% for BMS; odds ratio: 1.05; 95% confidence interval [CI]: 0.51 to 2.15; p = 1.000). The overall rate of ST did not differ significantly between patients receiving sirolimus- or paclitaxel-eluting stents (0.57% vs. 0.58%; p = 1.000). We found a significant relation between the rate of ST and the stented length (Y = 1.455 + 0.121 X; 95% CI for beta: 0.014 to 0.227; R = 0.716; p = 0.031). In patients with DES, mean stented length was longer in those suffering ST (23.4 ± 8.1 mm vs. 21.3 ± 4.1 mm, p = 0.025).
CONCLUSIONS: Drug-eluting stents do not increase the risk of ST, at least under appropriate anti-platelet therapy. The risk of ST after DES implantation is related to stent length.
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Abbreviations and Acronyms
| | BMS = bare-metal stents | | CI = confidence interval | | DES = drug-eluting stent | | LST = late stent thrombosis | | OR = odds ratio | | ST = stent thrombosis |
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Premature discontinuation of antiplatelet therapy in patients with drug-eluting coronary stents
Am. J. Health Syst. Pharm.,
December 1, 2006;
63(23):
2308 - 2310.
[Full Text]
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D. R. Holmes Jr, J. W. Moses, J. Schofer, M.-C. Morice, E. Schampaert, and M. B. Leon
Cause of death with bare metal and sirolimus-eluting stents
Eur. Heart J.,
December 1, 2006;
27(23):
2815 - 2822.
[Abstract]
[Full Text]
[PDF]
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F. Saia, G. Piovaccari, A. Manari, A. Santarelli, A. Benassi, E. Aurier, P. Sangiorgio, F. Tarantino, G. Geraci, G. Vecchi, et al.
Clinical Outcomes for Sirolimus-Eluting Stents and Polymer-Coated Paclitaxel-Eluting Stents in Daily Practice: Results From a Large Multicenter Registry
J. Am. Coll. Cardiol.,
October 3, 2006;
48(7):
1312 - 1318.
[Abstract]
[Full Text]
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W. Desmet
Delayed neointimal healing after drug-eluting stent implantation: seeing is believing
Eur. Heart J.,
September 2, 2006;
27(18):
2147 - 2149.
[Full Text]
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H. B. Barner
Status of percutaneous coronary intervention and coronary artery bypass.
Eur. J. Cardiothorac. Surg.,
September 1, 2006;
30(3):
419 - 424.
[Abstract]
[Full Text]
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D. J. Kereiakes, H. Wang, J. J. Popma, R. E. Kuntz, D. J. Donohoe, J. Schofer, E. Schampaert, B. Meier, M. B. Leon, and J. W. Moses
Periprocedural and Late Consequences of Overlapping Cypher Sirolimus-Eluting Stents: Pooled Analysis of Five Clinical Trials
J. Am. Coll. Cardiol.,
July 4, 2006;
48(1):
21 - 31.
[Abstract]
[Full Text]
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A. Colombo and S. J. Corbett
Drug-Eluting Stent Thrombosis: Increasingly Recognized But Too Frequently Overemphasized
J. Am. Coll. Cardiol.,
July 4, 2006;
48(1):
203 - 205.
[Full Text]
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M. Joner, A. V. Finn, A. Farb, E. K. Mont, F. D. Kolodgie, E. Ladich, R. Kutys, K. Skorija, H. K. Gold, and R. Virmani
Pathology of Drug-Eluting Stents in Humans: Delayed Healing and Late Thrombotic Risk
J. Am. Coll. Cardiol.,
July 4, 2006;
48(1):
193 - 202.
[Abstract]
[Full Text]
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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]
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S. Tsimikas
Drug-Eluting Stents and Late Adverse Clinical Outcomes: Lessons Learned, Lessons Awaited
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
2112 - 2115.
[Full Text]
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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]
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P. Urban, A. H. Gershlick, G. Guagliumi, P. Guyon, C. Lotan, J. Schofer, A. Seth, J. E. Sousa, W. Wijns, C. Berge, et al.
Safety of Coronary Sirolimus-Eluting Stents in Daily Clinical Practice: One-Year Follow-Up of the e-Cypher Registry
Circulation,
March 21, 2006;
113(11):
1434 - 1441.
[Abstract]
[Full Text]
[PDF]
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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]
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F. Alfonso
Residual coronary dissections after drug-eluting stenting: the good, the bad, and the ugly
Eur. Heart J.,
March 1, 2006;
27(5):
503 - 505.
[Full Text]
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R. Seabra-Gomes
Percutaneous coronary interventions with drug eluting stents for diabetic patients.
Heart,
March 1, 2006;
92(3):
410 - 419.
[Full Text]
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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
Circulation,
February 28, 2006;
113(8):
1108 - 1113.
[Abstract]
[Full Text]
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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]
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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]
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H. Kaneda
Drug-Eluting Stent Thrombosis: A Pooled Analysis
J. Am. Coll. Cardiol.,
January 3, 2006;
47(1):
214 - 214.
[Full Text]
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R. Moreno, C. Fernandez, and C. Macaya
Drug-eluting stent thrombosis: Results from a pooled analysis including 10 randomized studies: Reply
J. Am. Coll. Cardiol.,
January 3, 2006;
47(1):
214 - 215.
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H. Kaneda
Drug-Eluting Stent Thrombosis: A Pooled Analysis
J. Am. Coll. Cardiol.,
December 13, 2005;
(2005)
j.jacc.2005.10.014v1.
[Full Text]
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R. Moreno, C. Fernandez, and C. Macaya
Drug-eluting stent thrombosis: Results from a pooled analysis including 10 randomized studies.REPLY
J. Am. Coll. Cardiol.,
December 13, 2005;
(2005)
j.jacc.2005.10.015v1.
[Full Text]
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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]
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