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Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients.
JACC Cardiovasc Interv 2013; 6(12):1267-74JC

Abstract

OBJECTIVES

This study sought to compare the risk of stent thrombosis among patients treated with bare-metal stents (BMS), first-generation drug-eluting stents (G1-DES), and second-generation drug-eluting stents (G2-DES) for a period of 3 years.

BACKGROUND

In patients undergoing coronary stenting, there is a scarcity of long-term follow-up data on cohorts large enough to compare rates of stent thrombosis across the stent generations.

METHODS

A total of 18,334 patients undergoing successful coronary stent implantation from 1998 to 2011 at 2 centers in Munich, Germany, were included in this study. Patients were stratified into 3 groups according to treatment with BMS, G1-DES, and G2-DES.

RESULTS

The cumulative incidence of definite stent thrombosis at 3 years was 1.5% with BMS, 2.2% with G1-DES, and 1.0% with G2-DES. On multivariate analysis, G1-DES compared with BMS showed a significantly higher risk of stent thrombosis (odds ratio [OR]: 2.05; 95% confidence interval [CI]: 1.47 to 2.86; p < 0.001). G2-DES were associated with a similar risk of stent thrombosis compared with BMS (OR: 0.82; 95% CI: 0.56 to 1.19; p = 0.30). Beyond 1 year, the risk of stent thrombosis was significantly increased with G1-DES compared with BMS (OR: 4.72; 95% CI: 2.01 to 11.1; p < 0.001), but not with G2-DES compared with BMS (OR: 1.01; 95% CI: 0.32 to 3.25; p = 0.98).

CONCLUSIONS

In a large cohort of unselected patients undergoing coronary stenting, compared with BMS, there was a significant excess risk of stent thrombosis at 3 years with G1-DES, driven by an increased risk of stent thrombosis events beyond 1 year. G2-DES were associated with a similar risk of stent thrombosis compared with BMS.

Authors+Show Affiliations

Deutsches Herzzentrum, Technische Universität, Munich, Germany.Deutsches Herzzentrum, Technische Universität, Munich, Germany.Deutsches Herzzentrum, Technische Universität, Munich, Germany.Deutsches Herzzentrum, Technische Universität, Munich, Germany.Deutsches Herzzentrum, Technische Universität, Munich, Germany.Deutsches Herzzentrum, Technische Universität, Munich, Germany.Deutsches Herzzentrum, Technische Universität, Munich, Germany.Medizinische Klinik, Klinikum Rechts der Isar, Munich, Germany.Deutsches Herzzentrum, Technische Universität, Munich, Germany.Medizinische Klinik, Klinikum Rechts der Isar, Munich, Germany.Deutsches Herzzentrum, Technische Universität, Munich, Germany.Klinikum der Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research; partner site Munich Heart Alliance), Munich, Germany.Medizinische Klinik, Klinikum Rechts der Isar, Munich, Germany; DZHK (German Centre for Cardiovascular Research; partner site Munich Heart Alliance), Munich, Germany.Deutsches Herzzentrum, Technische Universität, Munich, Germany; DZHK (German Centre for Cardiovascular Research; partner site Munich Heart Alliance), Munich, Germany. Electronic address: kastrati@dhm.mhn.de.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24355117

Citation

Tada, Tomohisa, et al. "Risk of Stent Thrombosis Among Bare-metal Stents, First-generation Drug-eluting Stents, and Second-generation Drug-eluting Stents: Results From a Registry of 18,334 Patients." JACC. Cardiovascular Interventions, vol. 6, no. 12, 2013, pp. 1267-74.
Tada T, Byrne RA, Simunovic I, et al. Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients. JACC Cardiovasc Interv. 2013;6(12):1267-74.
Tada, T., Byrne, R. A., Simunovic, I., King, L. A., Cassese, S., Joner, M., ... Kastrati, A. (2013). Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients. JACC. Cardiovascular Interventions, 6(12), pp. 1267-74. doi:10.1016/j.jcin.2013.06.015.
Tada T, et al. Risk of Stent Thrombosis Among Bare-metal Stents, First-generation Drug-eluting Stents, and Second-generation Drug-eluting Stents: Results From a Registry of 18,334 Patients. JACC Cardiovasc Interv. 2013;6(12):1267-74. PubMed PMID: 24355117.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients. AU - Tada,Tomohisa, AU - Byrne,Robert A, AU - Simunovic,Iva, AU - King,Lamin A, AU - Cassese,Salvatore, AU - Joner,Michael, AU - Fusaro,Massimiliano, AU - Schneider,Simon, AU - Schulz,Stefanie, AU - Ibrahim,Tareq, AU - Ott,Ilka, AU - Massberg,Steffen, AU - Laugwitz,Karl-Ludwig, AU - Kastrati,Adnan, PY - 2013/03/27/received PY - 2013/06/07/revised PY - 2013/06/20/accepted PY - 2013/12/21/entrez PY - 2013/12/21/pubmed PY - 2014/8/29/medline KW - BMS KW - CI KW - DES KW - G1-DES KW - G2-DES KW - OR KW - ST-segment elevation myocardial infarction KW - STEMI KW - bare-metal stent(s) KW - confidence interval KW - drug-eluting stent(s) KW - first-generation drug-eluting stent(s) KW - odds ratio KW - second-generation drug-eluting stent(s) KW - stent thrombosis SP - 1267 EP - 74 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 6 IS - 12 N2 - OBJECTIVES: This study sought to compare the risk of stent thrombosis among patients treated with bare-metal stents (BMS), first-generation drug-eluting stents (G1-DES), and second-generation drug-eluting stents (G2-DES) for a period of 3 years. BACKGROUND: In patients undergoing coronary stenting, there is a scarcity of long-term follow-up data on cohorts large enough to compare rates of stent thrombosis across the stent generations. METHODS: A total of 18,334 patients undergoing successful coronary stent implantation from 1998 to 2011 at 2 centers in Munich, Germany, were included in this study. Patients were stratified into 3 groups according to treatment with BMS, G1-DES, and G2-DES. RESULTS: The cumulative incidence of definite stent thrombosis at 3 years was 1.5% with BMS, 2.2% with G1-DES, and 1.0% with G2-DES. On multivariate analysis, G1-DES compared with BMS showed a significantly higher risk of stent thrombosis (odds ratio [OR]: 2.05; 95% confidence interval [CI]: 1.47 to 2.86; p < 0.001). G2-DES were associated with a similar risk of stent thrombosis compared with BMS (OR: 0.82; 95% CI: 0.56 to 1.19; p = 0.30). Beyond 1 year, the risk of stent thrombosis was significantly increased with G1-DES compared with BMS (OR: 4.72; 95% CI: 2.01 to 11.1; p < 0.001), but not with G2-DES compared with BMS (OR: 1.01; 95% CI: 0.32 to 3.25; p = 0.98). CONCLUSIONS: In a large cohort of unselected patients undergoing coronary stenting, compared with BMS, there was a significant excess risk of stent thrombosis at 3 years with G1-DES, driven by an increased risk of stent thrombosis events beyond 1 year. G2-DES were associated with a similar risk of stent thrombosis compared with BMS. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/24355117/Risk_of_stent_thrombosis_among_bare_metal_stents_first_generation_drug_eluting_stents_and_second_generation_drug_eluting_stents:_results_from_a_registry_of_18334_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(13)01451-9 DB - PRIME DP - Unbound Medicine ER -