The Risk of Stent Thrombosis in Patients With Acute Coronary Syndromes Treated With Bare-Metal and Drug-Eluting Stents
Neville Kukreja, MA,
Yoshinobu Onuma, MD,
Hector M. Garcia-Garcia, MSc, MD,
Joost Daemen, MD,
Ron van Domburg, MD, PhD,
Patrick W. Serruys, MD, PhD* on behalf of the Interventional cardiologists of the Thoraxcenter (2000 to 2005)
Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
* Reprint requests and correspondence: Dr. Prof. P.W. Serruys, Thoraxcenter, Ba-583, ‘s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands (Email: p.w.j.c.serruys{at}erasmusmc.nl).
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.
Key Words: acute coronary syndromes • drug-eluting stents • percutaneous coronary intervention • stent thrombosis
|
Abbreviations and Acronyms
| | ACS = acute coronary syndrome | | BMS = bare-metal stent(s) | | DES = drug-eluting stent(s) | | HR = hazard ratio | | IQR = interquartile range | | MI = myocardial infarction | | NSTEMI = non–ST-segment elevation myocardial infarction | | PCI = percutaneous coronary intervention | | PES = paclitaxel-eluting stent(s) | | SA = stable angina | | SES = sirolimus-eluting stent(s) | | STEMI = ST-segment elevation myocardial infarction | | UA = unstable angina |
|
|
