Frequency of and Risk Factors for Stent Thrombosis After Drug-Eluting Stent Implantation During Long-Term Follow-Up

Park, Duk‐Woo; Park, Seong Wook; Park, Kyong Hwa; Lee, Bong Ki; Kim, Young Hak; Lee, Cheol Whan; Hong, Myeong Ki; Kim, Jae Joong; Park, Seung Jung

doi:10.1016/j.amjcard.2006.02.039

Cited by 437 publications

(292 citation statements)

References 15 publications

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“…In light of stent thrombosis, there have been great concerns about the long-term safety of DES associated with late stent thrombosis. 17,18 The primary stenting for STEMI was associated with a higher risk of stent thrombosis in registry data, 19,20 even though meta-analysis of randomized trials has not shown an increased risk of stent thrombosis in the DES group compared with bare metal stents (BMS) in the primary PCI. 21 Delayed healing characterized by persistent fibrin deposition, poorer endothelialization, and local hypersensitivity reaction are some of the mechanisms put forward for the explanation of the late occurrence of thrombosis-related events with DES.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Sirolimus‐ and Paclitaxel‐Eluting Stents in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: A Meta‐analysis of Randomized Trials

Zheng

Lu³

et al. 2010

Clinical Cardiology

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Background: It has been reported that sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) have been more effective than bare-metal stents in reducing restenosis and cardiac events in a broad range of patients with coronary artery disease. However, it is unknown whether there might be differences between these two drug-eluting stents in terms of efficacy and safety in the setting of acute ST-segment elevation myocardial infarction (STEMI). Hypothesis: The aim of the present study was to compare SES with PES in patients with acute STEMI undergoing primary percutaneous coronary intervention (PCI). Methods: The published research was scanned by formal searches of electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) from January 2001 to February 2010. Internet-based sources of information on the results of clinical trials in cardiology were also searched. Results: A total of 4 randomized trials were included in the present meta-analysis, involving 1105 patients (550 in the SES group, 555 in the PES group). SES were significantly more effective in the reduction of angiographic binary (≥50%) restenosis (4.0% vs 9.6%, odds ratio 0.38, 95% confidence interval 0.19 to 0.74, P = 0.004) compared to PES. The differences between SES and PES were not statistically significant with respect to target vessel revascularization (TVR), stent thrombosis, cardiac death, and myocardial infarction. Conclusions: SES are superior to PES in reducing the incidence of restenosis in patients undergoing primary PCI for STEMI, with nonsignificant differences in terms of TVR, cardiac death, myocardial infarction, and stent thrombosis. IntroductionPrimary angioplasty has become the standard of care for acute ST-segment elevation myocardial infarction (STEMI); however, its long-term success is limited by the occurrence of restenosis. 1,2 The introduction of drugeluting stents (DES) has greatly alleviated this problem, 3 and their use in coronary intervention has markedly increased. DES decreases angiographic and clinical measurements of restenosis compared with bare metal stents 4,5 in elective patients and those with STEMI. A meta-analysis in a broad population has shown that sirolimus-eluting stents (SES) are superior to paclitaxel-eluting stents (PES) in terms of late loss and target lesion revascularization (TLR). 6 However, the relative efficacy and safety of SES and PES in STEMI patients remains unclear. We therefore performed a meta-analysis of randomized

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Section: Discussionmentioning

confidence: 99%

Comparison of Sirolimus‐ and Paclitaxel‐Eluting Stents in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: A Meta‐analysis of Randomized Trials

Zheng

Lu³

et al. 2010

Clinical Cardiology

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“…STEMI is an independent predictor for acute or late stent thrombosis [33][34][35]. In our study, one sub-acute stent thrombosis was observed.…”

Section: Discussionmentioning

confidence: 75%

Bioresorbable everolimus-eluting vascular scaffold in patients with ST-segment elevation myocardial infarction: Optical coherence tomography evaluation and clinical outcomes

et al. 2015

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“…0.5% in those who had not prematurely discontinued therapy; p<0.001). 25 In another study, antiplatelet therapy had been discontinued after the procedure in 57% of the patients who developed stent thrombosis (versus 1.7% of patients who did not develop stent thrombosis [p<0.001]) in 652 patients who received sirolimus DES. 26 Moreover, a 9-fold higher likelihood of mortality over 11 months has been observed to occur in patients with acute MI treated with DES who discontinued thienopyridine therapy early, by 30 days (versus those who had not stopped their therapy early [p<0.0001]).…”

Section: Underuse Of Antiplatelet Strategies Postpercutaneous Coronarmentioning

confidence: 99%

Clinical Considerations with the Use of Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention

et al. 2008

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Despite the proven benefits of using antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI), a number of key questions remain to be answered. In recent years, clopidogrel dosing strategies among such patients have evolved considerably, with newer approaches involving loading doses prior to PCI and increases in the time interval and loading dosage in an effort to overcome variable responsiveness/hyporesponsiveness to platelet inhibition. Further, the role of glycoprotein (GP) IIb/IIIa antagonists in elective stenting continues to be defined, with recent evidence suggesting that most appropriate use of these agents is in high‐risk patients with elevated troponin levels. There appears to be a relationship between the use of GP IIb/IIIa antagonists with clopidogrel loading and attenuation of early inflammatory and cardiac marker release. Strategies to minimize the chance of late stent thrombosis in patients who receive drug‐eluting stents (DES) are also under intense investigation. Among some patients receiving sirolimus and paclitaxel DES, current standard long‐term antiplatelet strategies may be insufficient. Patient nonadherence to treatment and premature discontinuation and underutilization of antiplatelet therapies by physicians remain important clinical problems with potentially dire consequences. Copyright © 2008 Wiley Periodicals, Inc.

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Frequency of and Risk Factors for Stent Thrombosis After Drug-Eluting Stent Implantation During Long-Term Follow-Up

Cited by 437 publications

References 15 publications

Comparison of Sirolimus‐ and Paclitaxel‐Eluting Stents in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: A Meta‐analysis of Randomized Trials

Comparison of Sirolimus‐ and Paclitaxel‐Eluting Stents in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: A Meta‐analysis of Randomized Trials

Bioresorbable everolimus-eluting vascular scaffold in patients with ST-segment elevation myocardial infarction: Optical coherence tomography evaluation and clinical outcomes

Clinical Considerations with the Use of Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention

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