The risk of definitive stent thrombosis is increased after “off-label” stent implantation irrespective of drug-eluting stent or bare-metal stent use

Abstract

Implantation of coronary stents outside of the FDA-approved indications for DES is associated with an increased risk of stent thrombosis using DES and BMS.

Use and Misuse of Multivariable Approaches in Interventional Cardiology Studies on Drug‐Eluting Stents: A Systematic Review

“…Fifty‐eight studies were initially analyzed: 3 were excluded for reporting only multivariable analysis results, 14–16 2 because reporting only predictors of stent thrombosis, 17,18 3 because noncomparing directly BMS and DES 19–22 ; finally 50 studies were included (Fig. 1).…”

Major determinants for the uncovered stent struts on optical coherence tomography after drug-eluting stent implantation

“…Despite marked reduction in restenosis after DES implantation, late stent thrombosis has emerged as a major concern [18][19][20]. Previous pathologic studies of patients dying from late stent thrombosis have demonstrated that incomplete neointimal coverage of stent struts was the most important morphometric predictor of late stent thrombosis [2,21].…”

Impact of advanced age on the safety and effectiveness of paclitaxel‐eluting stent implantation in patients with ST‐segment elevation myocardial infarction undergoing primary angioplasty

“…However, some safety concerns with DES use have arisen after reports suggesting a higher incidence of late stent thrombosis associated with DES implantation in comparison to BMS, especially when implanted for off‐label indications, such as myocardial infarction . Also, unrestricted implantation of DES in the ACS setting was identified as an independent predictor of stent thrombosis . Conversely, in two more recent randomized studies , DES use was not associated with elevated risk of death, stent thrombosis, or reinfarction.…”

“…The introduction of drug‐eluting stents (DES) contributed to reducing the risk for TVR compared with the use of bare‐metal stents (BMS). Conversely, unrestricted implantation of DES in an acute coronary syndrome (ACS) setting was identified as an independent predictor of stent thrombosis . Large multicenter studies and two meta‐analyses of randomized trials have confirmed the safety and effectiveness of DES implantation during primary PCI in STEMI.…”