The Risk of Stent Thrombosis in Patients With Acute Coronary Syndromes Treated With Bare-Metal and Drug-Eluting Stents

Autor: Neville, Kukreja, Yoshinobu, Onuma, Hector M, Garcia-Garcia, Joost, Daemen, Ron, van Domburg, Patrick W, Serruys, C A, van Mieghem
Rok vydání: 2009
Předmět:
Drug
Male
Acute coronary syndrome
medicine.medical_specialty
Time Factors
Paclitaxel
media_common.quotation_subject
medicine.medical_treatment
Kaplan-Meier Estimate
Prosthesis Design
Risk Assessment
Angina Pectoris
Risk Factors
Internal medicine
medicine
Humans
acute coronary syndromes
Stent thrombosis
Registries
cardiovascular diseases
Acute Coronary Syndrome
Angioplasty
Balloon
Coronary
media_common
Aged
Proportional Hazards Models
Sirolimus
stent thrombosis
business.industry
Hazard ratio
percutaneous coronary intervention
Stent
Percutaneous coronary intervention
drug-eluting stents
Cardiovascular Agents
Thrombosis
Middle Aged
medicine.disease
equipment and supplies
Confidence interval
Treatment Outcome
surgical procedures
operative
Metals
Conventional PCI
Cardiology
Female
Stents
business
Cardiology and Cardiovascular Medicine
Zdroj: JACC: Cardiovascular Interventions. 2(6):534-541
ISSN: 1936-8798
DOI: 10.1016/j.jcin.2009.04.003
Popis: Objectives We aimed to evaluate the risk of definite stent thrombosis with bare-metal stents (BMS) and drug-eluting stents (DES) in patients treated for acute coronary syndromes. Background Acute coronary syndromes (ACS) have been reported as increasing the risk for stent thrombosis. Methods Between January 2000 and December 2005, 5,816 consecutive patients underwent percutaneous coronary intervention for de novo lesions with a single stent type. These patients consisted of 3 sequential groups of BMS (n = 2,248), sirolimus-eluting stents (n = 822) and paclitaxel-eluting stents (n = 2,746). In total, 3,485 patients presented with an ACS. Results After a median follow-up of 1,394 days, patients with ACS had a definite stent thrombosis rate of 2.5% versus 1.0% in patients with stable angina (propensity score-adjusted hazard ratio [HR]: 2.80, 95% confidence interval [CI]: 1.72 to 4.56). ACS patients had a higher risk of early and late stent thrombosis, although the increased risk of very late stent thrombosis was only present in ACS patients treated with DES. In stable patients, any stent thrombosis resulted in a significant increase in mortality (adjusted HR: 4.0, 95% CI: 1.7 to 9.3), although this was particularly evident for late or very late stent thrombosis; in contrast only early stent thrombosis significantly increased mortality in patients with acute coronary syndrome patients (adjusted HR: 2.0, 95% CI: 1.0 to 4.1). Conclusions Patients with acute coronary syndromes are at higher risk of early and late stent thrombosis with either BMS or DES, although very late stent thrombosis seems to be uniquely associated with DES. The clinical sequelae of late and very late stent thrombosis are more pronounced in stable patients.
Databáze: OpenAIRE
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