Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice -: 4-year results from a large 2-institutional cohort study

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:52

Article

Wenaweser, Peter¹  Daemen, Joost³  Zwahlen, Marcel²  van Domburg, Ron³  Jueni, Peter²  Vaina, Sophia³  Hellige, Gerrit¹  Tsuchida, Keiichi³  Morger, Cyrill¹  Boersma, Eric³  Kukreja, Neville³  Meier, Bernhard¹  Serruys, Patrick W.³  Windecker, Stephan¹ 

[1] Univ Hosp Bern, Dept Cardiol, CH-3010 Bern, Switzerland

[2] Univ Hosp Bern, Inst Social & Prevent Med, CH-3010 Bern, Switzerland

[3] Erasmus MC, Thoraxctr, Dept Intervent Cardiol, Rotterdam, Netherlands

关键词: drug-eluting stent;    mortality;    stent thrombosis;   

DOI  :  10.1016/j.jacc.2008.07.006

来源: Elsevier

【 摘 要 】

Objectives We sought to determine the risk of late stent thrombosis (ST) during long-term follow-up beyond 3 years, searched for predictors, and assessed the impact of ST on overall mortality. Background Late ST was reported to occur at an annual rate of 0.6% up to 3 years after drug-eluting stent (DES) implantation. Methods A total of 8,146 patients underwent percutaneous coronary intervention with a sirolimus-eluting stent (SES) (n = 3,823) or paclitaxel-eluting stent (PES) (n = 4,323) and were followed up to 4 years after stent implantation. Dual antiplatelet treatment was prescribed for 6 to 12 months. Results Definite ST occurred in 192 of 8,146 patients with an incidence density of 1.0/100 patient-years and a cumulative incidence of 3.3% at 4 years. The hazard of ST continued at a steady rate of 0.53% (95% confidence interval [CI]: 0.44 to 0.64) between 30 days and 4 years. Diabetes was an independent predictor of early ST (hazard ratio [HR]: 1.96; 95% CI: 1.18 to 3.28), and acute coronary syndrome (HR: 2.21; 95% CI: 1.39 to 3.51), younger age (HR: 0.97; 95% CI: 0.95 to 0.99), and use of PES (HR: 1.67; 95% CI: 1.08 to 2.56) were independent predictors of late ST. Rates of death and myocardial infarction at 4 years were 10.6% and 4.6%, respectively. Conclusions Late ST occurs steadily at an annual rate of 0.4% to 0.6% for up to 4 years. Diabetes is an independent predictor of early ST, whereas acute coronary syndrome, younger age, and PES implantation are associated with late ST.

【 授权许可】

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