Thrombosis and Drug-Eluting StentsAn Objective Appraisal
David R. Holmes, Jr, MD*,*,
Dean J. Kereiakes, MD ,
Warren K. Laskey, MD ,
Antonio Colombo, MD ,
Stephen G. Ellis, MD¶,
Timothy D. Henry, MD||,
Jeffrey J. Popma, MD#,
Patrick W.J.C. Serruys, MD**,
Takeshi Kimura, MD,
David O. Williams, MD,
Stephan Windecker, MD and
Mitchell W. Krucoff, MD¶¶
* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
The Heart Center of Greater Cincinnati and The Lindner Center at the Christ Hospital, Cincinnati, Ohio
Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
Columbus and San Rafaele Hospitals, Milan, Italy
¶ Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
|| Department of Research, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
# Brigham and Women’s Hospital, Boston, Massachusetts
** Thoraxcenter, Erasmus University, Rotterdam, the Netherlands
Department of Cardiovascular Medicine, Kyoto University School of Medicine, Kyoto, Japan
Division of Cardiology, Rhode Island Hospital, Providence, Rhode Island
Department of Cardiology, University Hospital Bern, Bern, Switzerland
¶¶ Department of Cardiology, Duke Clinical Research Institute, Durham, North Carolina.
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Figure 1 Effect of SES Versus BMS on Subsequent Death or Survival Free of Infarction
An analysis of 14 trials in 4,958 patients undergoing percutaneous coronary intervention with either sirolimus-eluting stents (SES) or bare-metal stents (BMS). There is no statistically significant difference in subsequent mortality (A) or survival free of myocardial infarction (B). Used with permission from Kastrati et al. (12).
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Figure 2 The 4-Year Follow-Up of Randomized Trials of SES Versus BMS and PES Versus BMS
At 4 years of follow-up, there is a slight but nonsignificant difference in mortality for both sirolimus-eluting stents (SES) (A) and paclitaxel-eluting stents (PES) (B) versus bare-metal stents (BMS) but no difference in myocardial infarction. The beneficial effect of both drug-eluting stents in reducing procedures for restenosis (target lesion revascularization) remain. Used with permission from Stone et al. (13).
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Figure 3 Cause of Death in Patients Randomized to SES Versus BMS
Kaplan-Meier curves of survival in patients randomized to control bare-metal stents (BMS) versus sirolimus (Cypher)-eluting stents (SES). The total mortality was slightly increased in the SES patients (A) but there was no difference in cardiac mortality (B). Used with permission from Holmes et al. (37).
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Figure 4 Follow-Up of Events Occurring in the BASKET-LATE Study
Major cardiac events during 7- to 18-month follow-up document no increase in fatal myocardial infarction (MI) (A). There is a nonstatistical increase in the rate of late stent thrombosis (B). BASKET-LATE = Basel Stent Kosten Effektivitats Trial-Late. Used with permission from Pfisterer et al. (43). BMS = bare-metal stents; DES = drug-eluting stents; MACE = major adverse cardiac events.
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