Stent Thrombosis, Myocardial Infarction, and Death After Drug-Eluting and Bare-Metal Stent Coronary Interventions

Jensen, Lisette Okkels; Mæng, Michael; Kaltoft, Anne; Thayssen, Per; Hansen, Henrik Lyngbeck; Böttcher, Morten; Lassen, Jens Flensted; Krussel, Lars Romer; Rasmussen, Klaus; Hansen, Knud Noerregaard; Pedersen, Lars; Johnsen, Soeren Paaske; Soerensen, Henrik Toft; Thuesen, Leif

doi:10.1016/j.jacc.2007.06.002

Cited by 232 publications

(149 citation statements)

References 23 publications

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“…The clinical trials have proved that DES can not only prevent the in-stent restenosis caused by early postoperative vascular wall recoil and long-term negative remodeling, but also can significantly reduce the in-stent restenosis caused by smooth muscle cell proliferation and neointimal hyperplasia. Though some studies [7,8] have found that DES could increase the risk of late stent thrombosis, clinical trails have proved that DES could significantly improve the long-term prognosis of patients with CHD. [3,4,[8][9][10] Since domestic DES Firebird was marketed in 2003, several other types of domestic DES have been put into clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Domestic versus imported drug-eluting stents for the treatment of patients with acute coronary syndrome

Yao

Sun

Wan

et al. 2014

World Journal of Emergency Medicine

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BACKGROUND:The application of coronary stents, especially drug-eluting stents (DESs), has made percutaneous coronary intervention (PCI) one of important therapeutic methods for CHD. DES has reduced the in-stent restenosis to 5%-9% and signifi cantly improved the long-term prognosis of patients with CHD. The study aimed to investigate the long-term effi cacy and safety of domestic drugeluting stents (DESs) in patients with acute coronary syndrome (ACS).METHODS: All patients with ACS who had undergone successful percutaneous coronary intervention (PCI) in the First Affi liated Hospital of Zhengzhou University from July 2009 to December 2010 were included in this study. Patients were excluded from the study if they were implanted with bare metal stents or different stents (domestic and imported DESs) simultaneously. The included patients were divided into two groups according to different stents implanted: domestic DESs and imported DESs. RESULTS:In the 1 683 patients of this study, 1 558 (92.6%) patients were followed up successfully for an average of (29.1±5.9) months. 130 (8.3%) patients had major adverse cardiovascular events (MACEs), including cardiac death in 32 (2.1%) patients, recurrent myocardial infarction in 16 (1%), and revascularization in 94 (6%). The rates of cardiac death, recurrent myocardial infarction, revascularization, in-stent restenosis, stent thrombosis and other MACEs were not signifi cantly different between the two groups (all P>0.05). Multivarite logistic regression revealed that diabetes mellitus (OR=1.75, 95%CI: 1.09-2.82, P=0.021), vascular numbers of PCI (OR=2.16, P=0.09) and PCI with left main lesion (OR=9.47, P=0.01) were independent prognostic factors of MACEs. The Kaplan-Meier method revealed that there was no significant difference in cumulative survival rates and survival rates free from clinical events between the two groups (all P>0.05). CONCLUSIONS:The incidences of clinical events and cumulative survival rates are not statistically different between domestic DESs and imported DESs. Domestic DES is effective and safe in the treatment of patients with ACS.

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Section: Discussionmentioning

confidence: 99%

Domestic versus imported drug-eluting stents for the treatment of patients with acute coronary syndrome

Yao

Sun

Wan

et al. 2014

World Journal of Emergency Medicine

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“…3) [14,15] and in 2006 the situation went out of control. Then the uncontested i ncreased risk of stent thrombosis at around 1 year of follow-up was inappropriately highlighted in an isolated manner by several reports [16,17]. They failed to point out clearly enough that they focused on the time around 1 year and they did not acknowledge the respective advantage in favour of DES accrued over the first year.…”

Section: Figurementioning

confidence: 99%

The infamous coronary stent saga

2014

Cardiovasc Med

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SummaryAgainst all odds, as a foreign body in a coronary artery was considered too thrombogenic, coronary artery stents have become a standard feature of percutaneous coronary intervention (PCI). After initial reluctance to employ coronary stents based on misinterpretation of thrombosis rates when stents were exclusively used for bail-out procedures, stent overuse took over quickly. Balloon angioplasty results indicated that only 25% of lesions can possibly benefit from a stent. A stent implanted in the remaining 75% of lesions is without any chance to help but carries some risk to harm. However, the risk of harm has become so small with ever improving stents that default stenting has become acceptable. Avid stent implanters argue that only 100% stenting assures that the 25% of lesions needing a stent indeed get a stent. Shortly after drug-eluting stents (DES) had been introduced, they were falsely accused of being dangerous on the ground of their higher propensity for stent thrombosis after the first year compared to bare metal stents (BMS). In fact, they had significantly fewer early stent thromboses during the first year irrespective of the extent of antiplatelet therapy. This advantage was admittedly progressively lost over the years. Subsequent generations of DES enhanced this early reduction of stent thrombosis but no longer showed that late catch-up phenomenon. T hese facts are ignored or misinterpreted to the present date by most physicians and all guidelines and textbooks. It was always preferable to implant a DES rather than a BMS when there was concern about stent thrombosis, be it because of need of early surgery or another impossibility to maintain double antiplatelet therapy. The respective advantage of current generation DES is overwhelming so that using a BMS is close to unethical. The most recent misconception, i.e., the need to have an absorbable stent, is also principally based on the myth of DES to be overly thrombogenic. The current absorbable stents disappear at best after a few years when the risk of a late stent thrombosis with a modern DES is virtually nil. Other reasons for absorbable stents, such as restitution of normal histology and vasomotion, easy accessibility of the stented segment for later bypass graft insertion, less stent malapposition to the vessel wall, and reduced need for antiplatelet therapy are either wrong or clinically trivial.

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“…9,16,18,20,21,33 However, the reduction of subsequent revascularization in registries was less than in clinical trials. The absolute reduction in target vessel revascularization at 4 years in a network meta-analysis of 38 clinical trials was about 12 vs. 2 -4% in the Swedish SCAAR registry at 3 years.…”

Section: Efficacymentioning

confidence: 99%

Meeting report ESC Forum on Drug Eluting Stents, European Heart House, Nice, 27-28 September 2007

et al. 2009

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Stent Thrombosis, Myocardial Infarction, and Death After Drug-Eluting and Bare-Metal Stent Coronary Interventions

Abstract: The minor risk of ST and MI within 15 months after implantation of DES seems unlikely to outweigh the benefit of these stents.

Cited by 232 publications

References 23 publications

Domestic versus imported drug-eluting stents for the treatment of patients with acute coronary syndrome

Domestic versus imported drug-eluting stents for the treatment of patients with acute coronary syndrome

The infamous coronary stent saga

Meeting report ESC Forum on Drug Eluting Stents, European Heart House, Nice, 27-28 September 2007

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