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J Am Coll Cardiol, 2007; 50:463-470, doi:10.1016/j.jacc.2007.06.002 (Published online 28 June 2007).
© 2007 by the American College of Cardiology Foundation
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EXPEDITED REVIEW

Stent Thrombosis, Myocardial Infarction, and Death After Drug-Eluting and Bare-Metal Stent Coronary Interventions

Lisette Okkels Jensen, MD, PhD*,*, Michael Maeng, MD, PhD{dagger}, Anne Kaltoft, MD, PhD{dagger}, Per Thayssen, MD, DMSci*, Hans Henrik Tilsted Hansen, MD{ddagger}, Morten Bottcher, MD, PhD{dagger}, Jens Flensted Lassen, MD, PhD{dagger}, Lars Romer Krussel, MD, DMSci{dagger}, Klaus Rasmussen, MD, DMSci{ddagger},§, Knud Noerregaard Hansen, MD*, Lars Pedersen, MSc||, Soeren Paaske Johnsen, MD, PhD§,||, Henrik Toft Soerensen, MD, DMSci, PhD||,¶ and Leif Thuesen, MD, DMSci{dagger}

* Department of Cardiology, Odense University Hospital, Odense, Denmark
{dagger} Department of Cardiology, Skejby Sygehus University, Aarhus, Denmark
|| Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
{ddagger} Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
§ Center of Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
Department of Epidemiology, Boston University, Boston, Massachusetts.

Manuscript received April 4, 2007; revised manuscript received May 21, 2007, accepted June 3, 2007.

* Reprint requests and correspondence: Dr. Lisette Okkels Jensen, Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark. (Email: okkels{at}dadlnet.dk).

Objectives: The aim of the study was to examine outcomes subsequent to implantation of drug-eluting stents (DES) and bare-metal stents (BMS).

Background: Use of DES might be associated with increased risk of stent thrombosis (ST), myocardial infarction (MI), and death.

Methods: From January 2002 through June 2005, data from all percutaneous coronary interventions in western Denmark were prospectively recorded in the Western Denmark Heart Registry; 12,395 consecutive patients (17,152 lesions) treated with stent implantation were followed for 15 months. Data on death and MI were ascertained from the national databases. The Academic Research Consortium definition of ST was used.

Results: The DES were implanted in 3,548 patients (5,422 lesions) and BMS were implanted in 8,847 patients (11,730 lesions). Definite, probable, or possible ST was found in 190 (2.15%) patients in the BMS group and in 64 (1.80%) patients in the DES. The risk of definite ST was similar in the 2 groups (DES: 0.65%; BMS: 0.61%). Very late definite ST (between 12 and 15 months after implantation) occurred more frequently in patients receiving DES (hazard ratio [HR] 10.93, 95% confidence interval [CI] 1.27 to 93.76). Also, the risk of MI between 12 and 15 months after implantation was higher in the DES group (HR 4.00, 95% CI 2.06 to 7.79). Mortality was similar in the 2 groups. Target lesion revascularization was reduced by 43% in patients treated with DES (HR 0.57, 95% CI 0.48 to 0.67).

Conclusions: The minor risk of ST and MI within 15 months after implantation of DES seems unlikely to outweigh the benefit of these stents.

Abbreviations and Acronyms
  BMS = bare-metal stent(s)
  CI = confidence interval
  DES = drug-eluting stent(s)
  FDA = Food and Drug Administration
  HR = hazard ratio
  MI = myocardial infarction
  PCI = percutaneous coronary intervention
  ST = stent thrombosis
  TLR = target lesion revascularization




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