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JACC Cardiovasc Interv. 2013 Dec;6(12):1267-74. doi: 10.1016/j.jcin.2013.06.015.

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.

Author information

1
Deutsches Herzzentrum, Technische Universität, Munich, Germany.
2
Medizinische Klinik, Klinikum Rechts der Isar, Munich, Germany.
3
Klinikum der Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research; partner site Munich Heart Alliance), Munich, Germany.
4
Medizinische Klinik, Klinikum Rechts der Isar, Munich, Germany; DZHK (German Centre for Cardiovascular Research; partner site Munich Heart Alliance), Munich, Germany.
5
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.

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.

KEYWORDS:

BMS; CI; DES; G1-DES; G2-DES; OR; ST-segment elevation myocardial infarction; STEMI; bare-metal stent(s); confidence interval; drug-eluting stent(s); first-generation drug-eluting stent(s); odds ratio; second-generation drug-eluting stent(s); stent thrombosis

PMID:
24355117
DOI:
10.1016/j.jcin.2013.06.015
[Indexed for MEDLINE]
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