Document Detail


Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study.
MedLine Citation:
PMID:  18804739     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to determine the risk of late stent thrombosis (ST) during long-term follow-up beyond 3 years, searched for predictors, and assessed the impact of ST on overall mortality. BACKGROUND: Late ST was reported to occur at an annual rate of 0.6% up to 3 years after drug-eluting stent (DES) implantation. METHODS: A total of 8,146 patients underwent percutaneous coronary intervention with a sirolimus-eluting stent (SES) (n=3,823) or paclitaxel-eluting stent (PES) (n=4,323) and were followed up to 4 years after stent implantation. Dual antiplatelet treatment was prescribed for 6 to 12 months. RESULTS: Definite ST occurred in 192 of 8,146 patients with an incidence density of 1.0/100 patient-years and a cumulative incidence of 3.3% at 4 years. The hazard of ST continued at a steady rate of 0.53% (95% confidence interval [CI]: 0.44 to 0.64) between 30 days and 4 years. Diabetes was an independent predictor of early ST (hazard ratio [HR]: 1.96; 95% CI: 1.18 to 3.28), and acute coronary syndrome (HR: 2.21; 95% CI: 1.39 to 3.51), younger age (HR: 0.97; 95% CI: 0.95 to 0.99), and use of PES (HR: 1.67; 95% CI: 1.08 to 2.56) were independent predictors of late ST. Rates of death and myocardial infarction at 4 years were 10.6% and 4.6%, respectively. CONCLUSIONS: Late ST occurs steadily at an annual rate of 0.4% to 0.6% for up to 4 years. Diabetes is an independent predictor of early ST, whereas acute coronary syndrome, younger age, and PES implantation are associated with late ST.
Authors:
Peter Wenaweser; Joost Daemen; Marcel Zwahlen; Ron van Domburg; Peter Jüni; Sophia Vaina; Gerrit Hellige; Keiichi Tsuchida; Cyrill Morger; Eric Boersma; Neville Kukreja; Bernhard Meier; Patrick W Serruys; Stephan Windecker
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  52     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-22     Completed Date:  2008-10-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1134-40     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, University of Bern, Bern, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Aged
Antibiotics, Antineoplastic / administration & dosage
Antineoplastic Agents, Phytogenic / administration & dosage
Coronary Thrombosis / etiology*,  mortality
Drug-Eluting Stents / adverse effects*
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Netherlands / epidemiology
Paclitaxel / administration & dosage
Postoperative Complications / epidemiology*
Risk Factors
Sirolimus / administration & dosage
Switzerland / epidemiology
Time Factors
Chemical
Reg. No./Substance:
0/Antibiotics, Antineoplastic; 0/Antineoplastic Agents, Phytogenic; 33069-62-4/Paclitaxel; 53123-88-9/Sirolimus

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