Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis

Stettler, Christoph; Wandel, Simon; Allemann, Sabin; Kastrati, Adnan; Morice, Marie Claude; Schömig, Albert; Pfisterer, Matthias; Stone, Gregg W.; Leon, Martin B.; Lezo, José Suarez de; Goy, Jean‐Jácques; Park, Seung‐Jung; Sabaté, Manel; Suttorp, Maarten J.; Kelbæk, Henning; Spaulding, Christian; Menichelli, Maurizio; Vermeersch, Paul; Dirksen, Maurits T.; Červinka, Pavel; Petronio, Anna Sonia; Nordmann, Alain; Diem, Peter; Meier, Bernhard; Zwahlen, Marcel; Reichenbach, Stephan; Trelle, Sven; Windecker, Stephan; Jüni, Peter

doi:10.1016/s0140-6736(07)61444-5

Cited by 1,318 publications

(860 citation statements)

References 62 publications

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“…In light of the relatively well‐preserved vascular structure and less severe luminal narrowing,1, 2, 9 it is conceivable that ACS caused by PE without significant luminal narrowing may be stabilized by effective antithrombotic treatment without stent implantation. This conservative strategy would avoid both early (vessel dissection, distal embolism, and acute stent thrombosis) and late (restenosis, neoatherosclerosis, and late and very late stent thrombosis) complications of stent implantation 10, 11, 12, 13, 14. Indeed, few reports with a small number of cases have suggested that a subset of patients with ST‐segment elevation myocardial infarction caused by PE might be treated by antithrombotic therapy with favorable outcome 2, 15, 16.…”

Section: Introductionmentioning

confidence: 99%

Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

Zhu

Zhang

et al. 2017

JAHA

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BackgroundPlaque rupture and erosion are the 2 most common mechanisms for acute coronary syndromes. However, the outcome of these 2 distinct pathologies in patients with acute coronary syndromes has never been studied.Methods and ResultsWe retrospectively studied 141 patients with acute coronary syndromes who underwent optical coherence tomography (OCT) imaging of the culprit lesion prior to stenting from the Massachusetts General Hospital OCT Registry. Management (stent versus no stent), poststent OCT findings, and outcomes were compared. Among the 141 culprit lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%). Stent implantation was performed in 77 (97.5%) patients with rupture versus 49 (79.0%) in those with erosion (P<0.001). Immediately after percutaneous coronary intervention, OCT showed a higher incidence of malapposition (37.5% versus 7.3%, P<0.001), thrombus (59.4% versus 14.6%, P<0.001), and protrusion (93.8% versus 73.2%, P=0.008) in the rupture group compared with the erosion group. Plaque rupture was associated with a higher incidence of no reflow or slow flow and distal embolization. Although cardiac event rates were comparable between the two groups at the 1‐year follow‐up, none of the erosion patients who were treated conservatively without stenting had adverse cardiac events.ConclusionsUnfavorable poststent OCT findings were more frequent in rupture patients compared with erosion patients. A subset of erosion patients who were treated conservatively without stenting remained free of adverse cardiac events for up to 1 year.

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Section: Introductionmentioning

confidence: 99%

Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

Zhu

Zhang

et al. 2017

JAHA

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“…[1][2][3] However, meta-analyses 4,5 and long-term followup data 6,7 demonstrated that DES improved morbidity but did not reduce mortality (compared with bare metal stents; BMS). Newer generation DES may solve the problems encountered with first-generation DES.…”

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confidence: 99%

TWENTE Study: The Real-World Endeavor Resolute Versus Xience V Drug-Eluting Stent Study in Twente: study design, rationale and objectives

Basalus

Tandjung²,

Houwelingen³

et al. 2010

NHJL

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“…6 Stettler and colleagues suggested that there is no evidence of an overall increase in definite stent thrombosis associated with SES between one and four years (0.3 vs. 0.2% in BMS). 7 However, the risk of LST seemed to be increased with PES (0.6%) with a significantly increased hazard ratio (2.1, p=0.017 vs. BMS between day 0 and 4 years). Garg and colleagues reported a small increase in DES thrombosis compared with BMS after one year (>0.14%/year).…”

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confidence: 85%

Late stent thrombosis, endothelialisation and drug-eluting stents

Ertaş

Beusekom²,

Giessen³

2009

NHJL

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Drug-eluting stents (DES) significantly reduce the risk of restenosis after percutaneous coronary revascularisation, but an increased risk of late stent thrombosis (LST) has been put forward as a major safety concern. Meta-analysis of clinical trials, however, does not support this caveat. Even so, many interventional cardiologists think that LST is associated with DES and related to delayed endothelialisation. This hypothesis is based on autopsy studies and clinical intracoronary angioscopy. In autopsy studies, differences between endothelialisation of DES and baremetal stents (BMS) have been reported. Most preclinical studies, however, have failed to show any significant differences in endothelialisation between DES and BMS. Our own studies, using the porcine coronary artery model, also suggest that DES show no differences in re-endothelialisation. However, DES do delay vascular healing and induce endothelial dysfunction. This paper will review clinical and animal studies which consider re-endothelialisation and LST. (Neth Heart J 2009;17:177-81.)Keywords: drug-eluting stents, stent thrombosis, endothelium, endothelial function P olymer-based sirolimus (SES) and paclitaxel (PES) eluting coronary stents have reduced rates of restenosis and late lumen loss compared with bare-metal stents (BMS), resulting in a significant reduction in the need for target vessel revascularisation. 1,2 Delayed healing and more specifically delayed re-endothelialisation after drug-eluting stent (DES) implantation have been suggested as the cause of late stent thrombosis (LST, defined as thrombosis ≥30 days after stent deployment). 3 This concept is based on clinical autopsy studies and clinical intracoronary angioscopy studies. 4,5 However we feel this concept is still open to debate. Our hypothesis is that delayed re-endothelialisation alone is not adequate to explain LST. The pathogenesis of LST is still not completely understood, and may be affected by a combination of factors. The present review discusses possible pathophysiological mechanisms of stent thrombosis in DES. DES induced late stent thrombosis, clinical studiesRecent reports from randomised trials suggest that some DES may be associated with increased rates of LST as compared with BMS. Stone et al. reported that both SES and PES were associated with a significant increase in the incidence of LST between one and four years after implantation (0.6 and 0.7%), as compared with BMS (0.2%). 6 Stettler and colleagues suggested that there is no evidence of an overall increase in definite stent thrombosis associated with SES between one and four years (0.3 vs. 0.2% in BMS). 7 However, the risk of LST seemed to be increased with PES (0.6%) with a significantly increased hazard ratio (2.1, p=0.017 vs. BMS between day 0 and 4 years). Garg and colleagues reported a small increase in DES thrombosis compared with BMS after one year (>0.14%/year). 8 This rate is, however, considerably lower than that reported by Daemen and Wenaweser and colleagues, who found that LST occurs in both D...

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Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis

Cited by 1,318 publications

References 62 publications

Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

TWENTE Study: The Real-World Endeavor Resolute Versus Xience V Drug-Eluting Stent Study in Twente: study design, rationale and objectives

Late stent thrombosis, endothelialisation and drug-eluting stents

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