Document Detail


The risk of stent thrombosis in patients with acute coronary syndromes treated with bare-metal and drug-eluting stents.
MedLine Citation:
PMID:  19539258     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Neville Kukreja; Yoshinobu Onuma; Hector M Garcia-Garcia; Joost Daemen; Ron van Domburg; Patrick W Serruys;
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  2     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-22     Completed Date:  2009-08-27     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  534-41     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / complications,  mortality,  therapy*
Aged
Angina Pectoris / complications,  mortality,  therapy*
Angioplasty, Balloon, Coronary / adverse effects*,  instrumentation*,  mortality
Cardiovascular Agents / administration & dosage
Drug-Eluting Stents*
Female
Humans
Kaplan-Meier Estimate
Male
Metals*
Middle Aged
Paclitaxel / administration & dosage
Proportional Hazards Models
Prosthesis Design
Registries
Risk Assessment
Risk Factors
Sirolimus / administration & dosage
Stents*
Thrombosis / etiology*,  mortality
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Cardiovascular Agents; 0/Metals; 33069-62-4/Paclitaxel; W36ZG6FT64/Sirolimus
Investigator
Investigator/Affiliation:
P J de Feyter / ; P P T de Jaegere / ; H J Duckers / ; S H Hofma / ; E McFadden / ; E Regar / ; G Sianos / ; P C Smits / ; M J van der Ent / ; W J van der Giessen / ; C A van Mieghem /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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