Published online before print May 21, 2007, doi: 10.1161/CIRCULATIONAHA.106.687186
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2007;115:2842-2847.)
© 2007 American Heart Association, Inc.
Interventional Cardiology |
Offsetting Impact of Thrombosis and Restenosis on the Occurrence of Death and Myocardial Infarction After Paclitaxel-Eluting and Bare Metal Stent Implantation
From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S.); Cleveland Clinic, Cleveland, Ohio (S.G.E.); San Raffaele Hospital, Milan, Italy (A.C.); Southampton University Hospital, Southampton, UK (K.D.D.); Heart Center Siegburg, Siegburg, Germany (E.G.); Harvard Clinical Research Institute, Boston, Mass (D.E.C.); and Boston Scientific Corp, Natick, Mass (M.F., D.S.B., J.K.).
Correspondence to Gregg W. Stone, MD, Columbia University Medical Center, The Cardiovascular Research Foundation, 111 E 59th St, 11th Floor, New York, NY 10022. E-mail gs2184{at}columbia.edu
Received December 27, 2006; accepted March 26, 2007.
Background— Drug-eluting stents compared with bare metal stents (BMS) may increase late stent thrombosis (ST), although an accompanying increase in the rates of death and myocardial infarction (MI) has not been observed. We hypothesized that the prevention of restenosis-related adverse events by drug-eluting stents might offset some or all of the excess risk from ST.
Methods and Results— We analyzed a pooled patient-level database from 4 prospective, double-blind trials in which 3445 patients were randomized to paclitaxel-eluting stents or BMS. The occurrence of death or MI within 7 days of ST or target lesion revascularization was assessed. With a median follow-up of 3.2 years, ST occurred in 34 patients (1.0%), 31 (91.1%) of whom sustained death or MI within 7 days. Target lesion revascularization was performed in 425 patients (12.3%), 15 (3.5%) of whom died or had MI within 7 days. ST occurred in 14 BMS and 20 paclitaxel-eluting stent patients, resulting in 12 and 19 deaths or MIs within 7 days, respectively. Target lesion revascularization was performed in 290 BMS and 135 paclitaxel-eluting stent patients, resulting in 11 and 4 deaths or MI events within 7 days, respectively. In total, 23 patients in both the BMS and paclitaxel-eluting stents groups died or had an MI event within 7 days of either ST or target lesion revascularization.
Conclusions— ST, although infrequent, results in a high incident rate of death and MI, whereas the more frequent occurrence of target lesion revascularization is associated with a finite but lower rate of death and MI. The marked reduction in restenosis with drug-eluting stents compared with BMS may counterbalance the potential excess risk from late ST with drug-eluting stents.
Key Words: mortality • myocardial infarction • restenosis • stent • thrombosis
This article has been cited by other articles:
 |
|
 |
|
  S. Silber, A. Colombo, A. P. Banning, K. Hauptmann, J. Drzewiecki, E. Grube, D. Dudek, and D. S. Baim Final 5-Year Results of the TAXUS II Trial: A Randomized Study to Assess the Effectiveness of Slow- and Moderate-Release Polymer-Based Paclitaxel-Eluting Stents for De Novo Coronary Artery Lesions Circulation, October 13, 2009; 120(15): 1498 - 1504. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y.-H. Kim, D.-W. Park, S.-W. Lee, S.-C. Yun, C. W. Lee, M.-K. Hong, S.-W. Park, K. B. Seung, H.-C. Gwon, M.-H. Jeong, et al. Long-Term Safety and Effectiveness of Unprotected Left Main Coronary Stenting With Drug-Eluting Stents Compared With Bare-Metal Stents Circulation, August 4, 2009; 120(5): 400 - 407. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Cook, E. Ladich, G. Nakazawa, P. Eshtehardi, M. Neidhart, R. Vogel, M. Togni, P. Wenaweser, M. Billinger, C. Seiler, et al. Correlation of Intravascular Ultrasound Findings With Histopathological Analysis of Thrombus Aspirates in Patients With Very Late Drug-Eluting Stent Thrombosis Circulation, August 4, 2009; 120(5): 391 - 399. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.-Y. Chen, S.-W. Rha, Y.-J. Li, K. L. Poddar, Z. Jin, Y. Minami, L. Wang, E. J. Kim, C. G. Park, H. S. Seo, et al. Triple Versus Dual Antiplatelet Therapy in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Circulation, June 30, 2009; 119(25): 3207 - 3214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Kirtane, A. Gupta, S. Iyengar, J. W. Moses, M. B. Leon, R. Applegate, B. Brodie, E. Hannan, K. Harjai, L. O. Jensen, et al. Safety and Efficacy of Drug-Eluting and Bare Metal Stents: Comprehensive Meta-Analysis of Randomized Trials and Observational Studies Circulation, June 30, 2009; 119(25): 3198 - 3206. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. W. Stone and G. S. Mintz Unprotected Left Main Intervention: The Light at the End of the Tunnel? Circ Cardiovasc Interv, June 1, 2009; 2(3): 156 - 158. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Ormiston and P. W.S. Serruys Bioabsorbable Coronary Stents Circ Cardiovasc Interv, June 1, 2009; 2(3): 255 - 260. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Niccoli, D. Schiavino, F. Belloni, G. Ferrante, G. La Torre, M. Conte, N. Cosentino, R. A. Montone, V. Sabato, F. Burzotta, et al. Pre-intervention eosinophil cationic protein serum levels predict clinical outcomes following implantation of drug-eluting stents Eur. Heart J., June 1, 2009; 30(11): 1340 - 1347. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. T. Ko, M. Chiu, H. Guo, P. C. Austin, R. Goeree, E. Cohen, M. Labinaz, and J. V. Tu Safety and effectiveness of drug-eluting and bare-metal stents for patients with off- and on-label indications. J. Am. Coll. Cardiol., May 12, 2009; 53(19): 1773 - 1782. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. N. Vaccarino, J. Thierer, M. Albertal, M. Vrancic, F. Piccinini, M. Benzadon, H. Raich, and D. O. Navia Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: a propensity score analysis. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 309 - 313. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Chen, L. V. Crisco, R. Jabara, and S. B. King III Late Angiographic Stent Thrombosis: The LAST Straw for Drug-Eluting Stents? Angiology, January 1, 2009; 59(6): 667 - 675. [Abstract] [PDF]
|
|
|
|
 |
|
 F. Crea, P. G. Camici, R. De Caterina, and G. A. Lanza CHAPTER 17 Chronic Ischaemic Heart Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Chhatriwalla and D. L. Bhatt Should dual antiplatelet therapy after drug-eluting stents be continued for more than 1 year?: Dual Antiplatelet Therapy After Drug-Eluting Stents Should Be Continued for More Than One Year and Preferably Indefinitely Circ Cardiovasc Interv, December 1, 2008; 1(3): 217 - 225. [Full Text] [PDF]
|
|
|
|
 |
|
 M. E Pfisterer Commentary on drug-eluting stents: to use or not to use--that is the question! Heart, December 1, 2008; 94(12): 1648 - 1650. [Full Text] [PDF]
|
|
|
|
|
|
F. Alfonso, M.-J. Perez-Vizcayno, R. Hernandez, A. Bethencourt, V. Marti, J. R. Lopez-Minguez, J. Angel, A. Iniguez, C. Moris, A. Cequier, et al. Long-Term Clinical Benefit of Sirolimus-Eluting Stents in Patients With In-Stent Restenosis: Results of the RIBS-II (Restenosis Intra-stent: Balloon angioplasty vs. elective sirolimus-eluting Stenting) Study J. Am. Coll. Cardiol., November 11, 2008; 52(20): 1621 - 1627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Shishehbor, S. S. Goel, S. R. Kapadia, D. L. Bhatt, P. Kelly, R. E. Raymond, J. M. Galla, S. J. Brener, P. L. Whitlow, and S. G. Ellis Long-Term Impact of Drug-Eluting Stents Versus Bare-Metal Stents on All-Cause Mortality J. Am. Coll. Cardiol., September 23, 2008; 52(13): 1041 - 1048. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. S. Wilson, H. S. Elbatarny, S. W. Crawley, B. M. Bennett, and D. H. Maurice Compartmentation and compartment-specific regulation of PDE5 by protein kinase G allows selective cGMP-mediated regulation of platelet functions PNAS, September 9, 2008; 105(36): 13650 - 13655. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Pfisterer Late Stent Thrombosis After Drug-Eluting Stent Implantation for Acute Myocardial Infarction: A New Red Flag Is Raised Circulation, September 9, 2008; 118(11): 1117 - 1119. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Stettler, S. Allemann, S. Wandel, A. Kastrati, M. C. Morice, A. Schomig, M. E Pfisterer, G. W Stone, M. B Leon, J. S. d. Lezo, et al. Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis BMJ, August 29, 2008; 337(aug29_3): a1331 - a1331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Holmes Jr and D. O. Williams Catheter-Based Treatment of Coronary Artery Disease: Past, Present, and Future Circ Cardiovasc Interv, August 1, 2008; 1(1): 60 - 73. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Malenka, A. V. Kaplan, F. L. Lucas, S. M. Sharp, and J. S. Skinner Outcomes Following Coronary Stenting in the Era of Bare-Metal vs the Era of Drug-Eluting Stents JAMA, June 25, 2008; 299(24): 2868 - 2876. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]
|
|
|
|
|
|
S.-H. Choi, A. Prasad, and S. Tsimikas The evolution of thienopyridine therapy clopidogrel duration, diabetes, and drug-eluting stents. J. Am. Coll. Cardiol., June 10, 2008; 51(23): 2228 - 2229. [Full Text] [PDF]
|
|
|
|
|
|
L. Mauri and S.-L. T. Normand Studies of Drug-Eluting Stents: To Each His Own? Circulation, April 22, 2008; 117(16): 2047 - 2050. [Full Text] [PDF]
|
|
|
|
|
|
M. Pfisterer, H. P. Brunner-La Rocca, and C. Kaiser The balance of risks and benefits of drug-eluting versus bare-metal stents. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 972 - 972. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Saia, A. Marzocchi, and A. Branzi Review: The safety of drug-eluting stents Therapeutic Advances in Cardiovascular Disease, February 1, 2008; 2(1): 43 - 52. [Abstract] [PDF]
|
|
|
|
|
|
D. Austin, J. P Pell, and K. G Oldroyd Drug-eluting stents: do the risks really outweigh the benefits? Heart, February 1, 2008; 94(2): 127 - 128. [Full Text] [PDF]
|
|
|
|
|
|
A. A. Bavry and D. L. Bhatt Drug-Eluting Stents: Dual Antiplatelet Therapy for Every Survivor? Circulation, August 14, 2007; 116(7): 696 - 699. [Full Text] [PDF]
|
|