CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Antonio Colombo, MD, FACC* and
Simon J. Corbett, PhD, MRCP
* EMO Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy (Email: info{at}emocolumbus.it).
We thank Dr. Joshi for his interest in our editorial (1). Our aim was not only to provide a perspective on the current state of play in the field, but also to give our opinion as to where the balance of evidence currently lies. In this regard, we believe that the reassurance provided by the available follow-up data from randomized trials (2,3) outweighs the understandable anxiety produced by reports of stent thrombosis in case series and anecdotal reports (4,5). On the basis of this we opted to use the word "overemphasized" in the title. This is most definitely not to say that we believe this issue should be underemphasized. Clearly, to exchange bare-metal stent restenosis for drug-eluting stent thrombosis would be a major and potentially catastrophic disservice to our patients. However, it should be borne in mind that, contrary to the balloon angioplasty data quoted by Dr. Joshi, in-stent restenosis is not always a benign event; more than one-third of cases of restenosis in bare-metal stents present as acute coronary events (6), whereas 2 of 23 patients described in the study by Joner et al. (7) died of drug-eluting stent restenosis. The issue of stent thrombosis in the drug-eluting stent era is obviously one of considerable controversy. We have no doubt that plenty of data are yet to emerge that will alternately fan and quell the flames of this particular debate, providing it with the attention and, more importantly, illumination that we all believe it deserves.
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References
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- Colombo A, Corbett SJ. Drug-eluting stent thrombosis: increasingly recognized but too frequently overemphasized J Am Coll Cardiol 2006;48:203-205.[Free Full Text]
- Moreno R, Fernández C, Hernández R, et al. Drug-eluting stent thrombosis results from a pooled analysis including 10 randomized studies J Am Coll Cardiol 2005;45:954-959.[Abstract/Free Full Text]
- Weisz G, Moses JW, Schofer J, et al. Late stent thrombosis in sirolimus-eluting versus bare metal stents in 4 randomized clinical trials with 3-year follow-up J Am Coll Cardiol 2006;47(Suppl B):8B.
- Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents JAMA 2005;293:2126-2130.[Abstract/Free Full Text]
- Pfisterer ME, Kaiser CA, Bader F, et al. Late clinical events related to late stent thrombosis after stopping clopidogrel: prospective randomized comparison between drug-eluting versus bare-metal stenting 2006Available at: http://www.cardiosource.com/pops/trailSum.asp?trialID=1424. Accessed April 27.
- Chen MS, John JM, Chew DP, et al. Bare metal stent restenosis is not a benign clinical entity Am Heart J 2006;151:1260-1264.[CrossRef][ISI][Medline]
- Joner M, Finn AV, Farb A, et al. Pathology of drug eluting stents in man: delayed healing and late thrombotic risk J Am Coll Cardiol 2006;48:193-202.[Abstract/Free Full Text]
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References