Document Detail

Late Adverse Events After Implantation of Sirolimus-Eluting Stent and Bare-Metal Stent: Long-Term (5-7 Years) Follow-Up of the Coronary Revascularization Demonstrating Outcome Study-Kyoto Registry Cohort-2.
MedLine Citation:
PMID:  24550439     Owner:  NLM     Status:  Publisher    
BACKGROUND: Late adverse events such as very late stent thrombosis (VLST) or late target-lesion revascularization (TLR) after first-generation sirolimus-eluting stents (SES) implantation have not been yet fully characterized at long term in comparison with those after bare-metal stent (BMS) implantation.
METHODS AND RESULTS: Among 13 058 consecutive patients undergoing first percutaneous coronary intervention in the Coronary REvascularization Demonstrating Outcome study-Kyoto registry Cohort-2, 5078 patients were treated with SES only, and 5392 patients were treated with BMS only. During 7-year follow-up, VLST and late TLR beyond 1 year after SES implantation occurred constantly and without attenuation at 0.24% per year and at 2.0% per year, respectively. Cumulative 7-year incidence of VLST was significantly higher in the SES group than that in the BMS group (1.43% versus 0.68%, P<0.0001). However, there was no excess of all-cause death beyond 1 year in the SES group as compared with that in the BMS group (20.8% versus 19.6%, P=0.91). Cumulative incidences of late TLR (both overall and clinically driven) were also significantly higher in the SES group than in the BMS group (12.0% versus 4.1%, P<0.0001 and 8.5% versus 2.6%, P<0.0001, respectively), leading to late catch-up of the SES group to the BMS group regarding TLR through the entire 7-year follow-up (18.8% versus 25.2%, and 10.6% versus 10.2%, respectively). Clinical presentation as acute coronary syndrome was more common at the time of late SES TLR compared with early SES TLR (21.2% and 10.0%).
CONCLUSIONS: Late catch-up phenomenon regarding stent thrombosis and TLR was significantly more pronounced with SES than that with BMS. This limitation should remain the target for improvements of DES technology.
Masahiro Natsuaki; Takeshi Morimoto; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Kyohei Yamaji; Kenji Ando; Satoshi Shizuta; Hiroki Shiomi; Tomohisa Tada; Junichi Tazaki; Yoshihiro Kato; Mamoru Hayano; Mitsuru Abe; Takashi Tamura; Manabu Shirotani; Shinji Miki; Mitsuo Matsuda; Mamoru Takahashi; Katsuhisa Ishii; Masaru Tanaka; Takeshi Aoyama; Osamu Doi; Ryuichi Hattori; Masayuki Kato; Satoru Suwa; Akinori Takizawa; Yoshiki Takatsu; Eiji Shinoda; Hiroshi Eizawa; Teruki Takeda; Jong-Dae Lee; Moriaki Inoko; Hisao Ogawa; Shuichi Hamasaki; Minoru Horie; Ryuji Nohara; Hirofumi Kambara; Hisayoshi Fujiwara; Kazuaki Mitsudo; Masakiyo Nobuyoshi; Toru Kita; Takeshi Kimura;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-2-18
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-2-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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