Very Late Coronary Stent Thrombosis of a Newer-Generation Everolimus-Eluting Stent Compared With Early-Generation Drug-Eluting Stents

Author:

Räber Lorenz1,Magro Michael1,Stefanini Giulio G.1,Kalesan Bindu1,van Domburg Ron T.1,Onuma Yoshinobu1,Wenaweser Peter1,Daemen Joost1,Meier Bernhard1,Jüni Peter1,Serruys Patrick W.1,Windecker Stephan1

Affiliation:

1. From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (L.R., G.G.S., P.W., B.M., S.W.); Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands (L.R., M.M., R.T.v.D., Y.O., J.D., P.W.S.); and Institute of Social and Preventive Medicine (B.K., P.J.) and Clinical Trials Unit Bern, Department of Clinical Research (P.J., S.W.), University of Bern, Bern, Switzerland.

Abstract

Background— Early-generation drug-eluting stents releasing sirolimus (SES) or paclitaxel (PES) are associated with increased risk of very late stent thrombosis occurring >1 year after stent implantation. It is unknown whether the risk of very late stent thrombosis persists with newer-generation everolimus-eluting stents (EES). Methods and Results— We assessed the risk of stent thrombosis in a cohort of 12 339 patients with unrestricted use of drug-eluting stents (3819 SES, 4308 PES, 4212 EES). Results are incidence rates per 100 person-years after inverse probability of treatment weighting to adjust for group differences. During follow-up of up to 4 years, the overall incidence rate of definite stent thrombosis was lower with EES (1.4 per 100 person-years) compared with SES (2.9; hazard ratio, 0.41; 95% confidence interval, 0.27–0.62; P <0.0001) and PES (4.4; hazard ratio, 0.33; 95% confidence interval, 0.23–0.48; P <0.0001). The incidence rate per 100 person-years of early (0–30 days), late (31 days–1 year), and very late stent thrombosis amounted to 0.6, 0.1, and 0.6 among EES-treated patients; 1.0, 0.3, and 1.6 among SES-treated patients; and 1.3, 0.7, and 2.4 among PES-treated patients. Differences in favor of EES were most pronounced beyond 1 year, with a hazard ratio of 0.33 (EES versus SES; P =0.006) and 0.34 (EES versus PES; P <0.0001). There was a lower risk of cardiac death or myocardial with EES compared with PES (hazard ratio, 0.65; 95% confidence interval, 0.56–0.75; P <0.0001), which was directly related to the lower risk of stent thrombosis–associated events (EES versus PES: hazard ratio, 0.36; 95% confidence interval, 0.23–0.57). Conclusion— Current treatment with EES is associated with a lower risk of very late stent thrombosis compared with early-generation drug-eluting stents.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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