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The risk of stent thrombosis in patients with acute coronary syndromes treated with bare-metal and drug-eluting stents.
JACC Cardiovasc Interv. 2009 Jun; 2(6):534-41.JC

Abstract

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+Show Affiliations

Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19539258

Citation

Kukreja, Neville, et al. "The Risk of Stent Thrombosis in Patients With Acute Coronary Syndromes Treated With Bare-metal and Drug-eluting Stents." JACC. Cardiovascular Interventions, vol. 2, no. 6, 2009, pp. 534-41.
Kukreja N, Onuma Y, Garcia-Garcia HM, et al. The risk of stent thrombosis in patients with acute coronary syndromes treated with bare-metal and drug-eluting stents. JACC Cardiovasc Interv. 2009;2(6):534-41.
Kukreja, N., Onuma, Y., Garcia-Garcia, H. M., Daemen, J., van Domburg, R., & Serruys, P. W. (2009). The risk of stent thrombosis in patients with acute coronary syndromes treated with bare-metal and drug-eluting stents. JACC. Cardiovascular Interventions, 2(6), 534-41. https://doi.org/10.1016/j.jcin.2009.04.003
Kukreja N, et al. The Risk of Stent Thrombosis in Patients With Acute Coronary Syndromes Treated With Bare-metal and Drug-eluting Stents. JACC Cardiovasc Interv. 2009;2(6):534-41. PubMed PMID: 19539258.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The risk of stent thrombosis in patients with acute coronary syndromes treated with bare-metal and drug-eluting stents. AU - Kukreja,Neville, AU - Onuma,Yoshinobu, AU - Garcia-Garcia,Hector M, AU - Daemen,Joost, AU - van Domburg,Ron, AU - Serruys,Patrick W, AU - ,, PY - 2008/08/28/received PY - 2009/03/16/revised PY - 2009/04/06/accepted PY - 2009/6/23/entrez PY - 2009/6/23/pubmed PY - 2009/8/28/medline SP - 534 EP - 41 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 2 IS - 6 N2 - 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. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/19539258/The_risk_of_stent_thrombosis_in_patients_with_acute_coronary_syndromes_treated_with_bare_metal_and_drug_eluting_stents_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(09)00254-4 DB - PRIME DP - Unbound Medicine ER -