Stent thrombosis Relation to drug eluting stents: Difference between revisions

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{{SI}}
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{{WikiDoc Cardiology Network Infobox}}
{{Stent thrombosis}}
{{CMG}}
{{CMG}}; '''Associate Editor-In-Chief:'''  Smita Kohli, M.D.; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.


{{Editor Help}}
==Overview==
Overall lifetime incidence of [[stent thrombosis]] (ST) in patients with [[drug eluting stent]](DES), from multiple trials is in the range of '''0.5-2%'''. How ever there is wide variation of the incidence depending on the multiple variables which influence its occurrence.
==Relation to Drug Eluting Stents==
===Incidence in Drug Eluting Stents===
*In a study of 3548 registry patients who received a [[DES]], the cumulative incidence of definite, probable or possible ST was '''1.8%'''. The incidence for definite ST was 0.65% over a 15 month period.<ref name="pmid17662400">{{cite journal| author=Jensen LO, Maeng M, Kaltoft A, Thayssen P, Hansen HH, Bottcher M et al.| title=Stent thrombosis, myocardial infarction, and death after drug-eluting and bare-metal stent coronary interventions. | journal=J Am Coll Cardiol | year= 2007 | volume= 50 | issue= 5 | pages= 463-70 | pmid=17662400 | doi=10.1016/j.jacc.2007.06.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17662400  }} </ref>


Overall lifetime incidence of [[stent thrombosis]](ST) in patients with [[drug eluting stent]](DES), from multiple trials is in the range of 0.5-2%. How ever there is wide variation of the incidence depending on the multiple variables which influence its occurrence.
*In a study of 1911 patients with [[DES]] and a follow up to a median 19.4 months , the overall incidence of ST was '''0.8%'''.<ref name="pmid16860022">{{cite journal| author=Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW et al.| title=Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. | journal=Am J Cardiol | year= 2006 | volume= 98 | issue= 3 | pages= 352-6 | pmid=16860022 | doi=10.1016/j.amjcard.2006.02.039 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16860022  }} </ref>


In a study of 3548 registry patients who received a DES, the cumulative incidence of definite, probable or possible ST was 1.8 %. The incidence for definite ST was 0.65% over a 15 month period.<ref name="pmid17662400">{{cite journal| author=Jensen LO, Maeng M, Kaltoft A, Thayssen P, Hansen HH, Bottcher M et al.| title=Stent thrombosis, myocardial infarction, and death after drug-eluting and bare-metal stent coronary interventions. | journal=J Am Coll Cardiol | year= 2007 | volume= 50 | issue= 5 | pages= 463-70 | pmid=17662400 | doi=10.1016/j.jacc.2007.06.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17662400 }} </ref>
*In a study of 1731 patients undergoing [[sirolimus]] eluting stent(SES) implantation the cumulative one year ST rate was '''1.7%'''. This number was 3.2% for [[diabetics]].<ref name="pmid17678732">{{cite journal| author=Machecourt J, Danchin N, Lablanche JM, Fauvel JM, Bonnet JL, Marliere S et al.| title=Risk factors for stent thrombosis after implantation of sirolimus-eluting stents in diabetic and nondiabetic patients: the EVASTENT Matched-Cohort Registry. | journal=J Am Coll Cardiol | year= 2007 | volume= 50 | issue= 6 | pages= 501-8 | pmid=17678732 | doi=10.1016/j.jacc.2007.04.051 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17678732 }} </ref>


In a study of 1911 patients with DES and a follow up to a median 19.4 months , the overall incidence of ST was 0.8%.<ref name="pmid16860022">{{cite journal| author=Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW et al.| title=Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. | journal=Am J Cardiol | year= 2006 | volume= 98 | issue= 3 | pages= 352-6 | pmid=16860022 | doi=10.1016/j.amjcard.2006.02.039 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16860022 }} </ref>
*In a “real world” observational study involving 15157 patients with [[SES]] acturial incidence of ST at 12 months was '''0.87%'''.<ref name="pmid16534015">{{cite journal| author=Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J et al.| title=Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. | journal=Circulation | year= 2006 | volume= 113 | issue= 11 | pages= 1434-41 | pmid=16534015 | doi=10.1161/CIRCULATIONAHA.104.532242 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16534015 }} </ref>
===Incidence of Early Stent Thrombosis with Drug Eluting Stents===
This group would include
#'''Intra-procedural ST'''
#'''Acute ST:''' up to 24 hrs
#'''Subacute ST:''' 24 hrs to 30 days


In a study of 1731 patients undergoing [[sirolimus]] eluting stent(SES) implantation the cumulative one year ST rate was 1.7%. This number was 3.2% for diabetics.<ref name="pmid17678732">{{cite journal| author=Machecourt J, Danchin N, Lablanche JM, Fauvel JM, Bonnet JL, Marliere S et al.| title=Risk factors for stent thrombosis after implantation of sirolimus-eluting stents in diabetic and nondiabetic patients: the EVASTENT Matched-Cohort Registry. | journal=J Am Coll Cardiol | year= 2007 | volume= 50 | issue= 6 | pages= 501-8 | pmid=17678732 | doi=10.1016/j.jacc.2007.04.051 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17678732 }} </ref>
*'''Intra-procedural''' ST occurred in '''0.7%''' of patients in a study of 670 patients with 1362 lesions who received a [[SES]]. The average stent length was 42.9 ± 28.3 mm.<ref name="pmid15148281">{{cite journal| author=Chieffo A, Bonizzoni E, Orlic D, Stankovic G, Rogacka R, Airoldi F et al.| title=Intraprocedural stent thrombosis during implantation of sirolimus-eluting stents. | journal=Circulation | year= 2004 | volume= 109 | issue= 22 | pages= 2732-6 | pmid=15148281 | doi=10.1161/01.CIR.0000131890.83839.5B | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15148281 }} </ref>


In a “real world” observational study involving 15157 patients with SES acturial incidence of ST at 12 months was 0.87%.<ref name="pmid16534015">{{cite journal| author=Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J et al.| title=Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. | journal=Circulation | year= 2006 | volume= 113 | issue= 11 | pages= 1434-41 | pmid=16534015 | doi=10.1161/CIRCULATIONAHA.104.532242 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16534015 }} </ref>
*A rate of '''0.5%''' of '''acute''' ST was observed in a study of 1911 patients who were treated with [[aspirin]], [[clopidogrel]] and on the discretion of the treating physician.<ref name="pmid16860022">{{cite journal| author=Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW et al.| title=Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. | journal=Am J Cardiol | year= 2006 | volume= 98 | issue= 3 | pages= 352-6 | pmid=16860022 | doi=10.1016/j.amjcard.2006.02.039 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16860022 }} </ref>


==Incidence of early [[stent thrombosis]] (ST) with drug eluting stents ([[DES]])==
*A meta-analysis of 10 RCT involving 2602 patientes who received a [[DES]], showed a ST rate of '''0.34%''' by '''30th day'''.<ref name="pmid15766835">{{cite journal| author=Moreno R, Fernández C, Hernández R, Alfonso F, Angiolillo DJ, Sabaté M et al.| title=Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 6 | pages= 954-9 | pmid=15766835 | doi=10.1016/j.jacc.2004.11.065 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15766835  }} </ref>
*This group would include
**'''Intra-procedural ST'''
**'''Acute ST:''' up to 24 hrs
**'''Subacute ST:''' 24 hrs to 30 days


Intra-procedural ST occurred in 0.7% of patients in a study of 670 patients with 1362 lesions who received a SES. The average stent legth was 42.9±28.3 mm.<ref name="pmid15148281">{{cite journal| author=Chieffo A, Bonizzoni E, Orlic D, Stankovic G, Rogacka R, Airoldi F et al.| title=Intraprocedural stent thrombosis during implantation of sirolimus-eluting stents. | journal=Circulation | year= 2004 | volume= 109 | issue= 22 | pages= 2732-6 | pmid=15148281 | doi=10.1161/01.CIR.0000131890.83839.5B | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15148281 }} </ref>
*In the real world setting a review of the e-cypher registry involving 15157 patients with [[SES]], rate of '''sub-acute''' ST was '''0.56%'''.<ref name="pmid16534015">{{cite journal| author=Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J et al.| title=Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. | journal=Circulation | year= 2006 | volume= 113 | issue= 11 | pages= 1434-41 | pmid=16534015 | doi=10.1161/CIRCULATIONAHA.104.532242 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16534015 }} </ref>


A rate of 0.5% of acute ST was observed in a study of 1911 patients who were treated with aspirin, clopidogrel and on the discretion of the treating physician.<ref name="pmid16860022">{{cite journal| author=Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW et al.| title=Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. | journal=Am J Cardiol | year= 2006 | volume= 98 | issue= 3 | pages= 352-6 | pmid=16860022 | doi=10.1016/j.amjcard.2006.02.039 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16860022 }} </ref>
*An incidence '''subacute''' ST of '''0.83 %''' was reported in a meta-analysis of 19 randomised controlled trails.<ref name="pmid16216853">{{cite journal| author=Roiron C, Sanchez P, Bouzamondo A, Lechat P, Montalescot G| title=Drug eluting stents: an updated meta-analysis of randomised controlled trials. | journal=Heart | year= 2006 | volume= 92 | issue= 5 | pages= 641-9 | pmid=16216853 | doi=10.1136/hrt.2005.061622 | pmc=PMC1860942 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16216853 }} </ref>


A meta-analysis of 10 RCT involving 2602 patientes who received a DES, showed a ST rate of 0.34% by 30th day.<ref name="pmid15766835">{{cite journal| author=Moreno R, Fernández C, Hernández R, Alfonso F, Angiolillo DJ, Sabaté M et al.| title=Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 6 | pages= 954-9 | pmid=15766835 | doi=10.1016/j.jacc.2004.11.065 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15766835 }} </ref>
*In a large observational study of more than 8000 patients with [[DES]], the cumulative incidence of subacute stent thrombosis was '''1.1%''' at '''30 days'''.  This accounted for 60% of total ST.<ref name="pmid17321312">{{cite journal| author=Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C et al.| title=Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. | journal=Lancet | year= 2007 | volume= 369 | issue= 9562 | pages= 667-78 | pmid=17321312 | doi=10.1016/S0140-6736(07)60314-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17321312 }} </ref>


In the real world setting a review of the e-cypher registry involving 15157 patients with SES, rate of sub-acute ST was 0.56%.<ref name="pmid16534015">{{cite journal| author=Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J et al.| title=Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. | journal=Circulation | year= 2006 | volume= 113 | issue= 11 | pages= 1434-41 | pmid=16534015 | doi=10.1161/CIRCULATIONAHA.104.532242 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16534015  }} </ref>
===Incidence of Late Stent Thrombosis with Drug Eluting Stent===
This would include
#'''Late ST:''' 30 days to one year
#'''Very late ST:''' more than one year, but generally less than 3 years
#'''Later than 3 years'''


An incidence subacute ST of 0.83 % was reported in a meta-analysis of 19 randomised controlled trails.<ref name="pmid16216853">{{cite journal| author=Roiron C, Sanchez P, Bouzamondo A, Lechat P, Montalescot G| title=Drug eluting stents: an updated meta-analysis of randomised controlled trials. | journal=Heart | year= 2006 | volume= 92 | issue= 5 | pages= 641-9 | pmid=16216853 | doi=10.1136/hrt.2005.061622 | pmc=PMC1860942 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16216853 }} </ref>
*In a study of more than 8146 patients in two academic centers, the cumulative incidence of late stent thrombosis was '''1.7% at 1 year'''. The slope of the linear portion of the cumulative incidence curve between 30 days and 3 years indicated a steady rate of 0.6% per year.<ref name="pmid17321312">{{cite journal| author=Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C et al.| title=Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. | journal=Lancet | year= 2007 | volume= 369 | issue= 9562 | pages= 667-78 | pmid=17321312 | doi=10.1016/S0140-6736(07)60314-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17321312 }} </ref> Late stent thrombosis was more frequent with PES (1.8%) than with SES (1.4%). 23% of patients who developed late ST were being treated with dual antiplatelet therapy. This study concluded that late stent thrombosis was encountered steadily with no evidence of diminution up to 3 years of follow-up. Cumulative incidence of very late stent thrombosis was 2.3% at 2 years, and 2.9% at 3 years


In a large observational study of more than 8000 patients with DES, the cumulative incidence of subacute stent thrombosis was 1.1% at 30 days. This accounted for 60% of total ST.<ref name="pmid17321312">{{cite journal| author=Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C et al.| title=Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. | journal=Lancet | year= 2007 | volume= 369 | issue= 9562 | pages= 667-78 | pmid=17321312 | doi=10.1016/S0140-6736(07)60314-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17321312 }} </ref>
*In 1911 patients with [[DES]] with 100% follow-up, incidence of late ST was '''0.6%''' which was similar to that for [[bare metal stents]]. The predictors of stent thrombosis were premature [[antiplatelet]] therapy interruption, primary stenting in [[acute myocardial infarction]], and total stent length.<ref name="pmid16860022">{{cite journal| author=Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW et al.| title=Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. | journal=Am J Cardiol | year= 2006 | volume= 98 | issue= 3 | pages= 352-6 | pmid=16860022 | doi=10.1016/j.amjcard.2006.02.039 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16860022 }} </ref>


==Incidence of late ST in DES==
*A late angiographic ST rate of 0.35% (95% confidence limits 0.17% to 0.72%) was reported in a cohort of 2006 patients with 98% of the patients being followed up. The incidence of ST between '''30 days to 1 year''' was '''0.25%''' and incidence of '''very late''' ST was '''0.15%'''. Also concluded that ST may occur even if the patients are stable on antiplatelet monotherapy.<ref name="pmid15963413">{{cite journal| author=Ong AT, McFadden EP, Regar E, de Jaegere PP, van Domburg RT, Serruys PW| title=Late angiographic stent thrombosis (LAST) events with drug-eluting stents. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 12 | pages= 2088-92 | pmid=15963413 | doi=10.1016/j.jacc.2005.02.086 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15963413  }} </ref>
*This would include
**'''Late ST:''' 30 days to one year
**'''Very late ST:''' more than one year, but generally less than 3 years
**'''Later than 3 years'''


The annual incidence has been reported in the range of   0.6% to %. The reported cumulative incidence has been from %  to  %.
*An incidence '''late''' ST of '''0.7 %''' was reported in a meta-analysis of 19 RCT.<ref name="pmid16216853">{{cite journal| author=Roiron C, Sanchez P, Bouzamondo A, Lechat P, Montalescot G| title=Drug eluting stents: an updated meta-analysis of randomised controlled trials. | journal=Heart | year= 2006 | volume= 92 | issue= 5 | pages= 641-9 | pmid=16216853 | doi=10.1136/hrt.2005.061622 | pmc=PMC1860942 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16216853  }} </ref>


In a study of more than 8000 patients in two academic centers, the cumulative incidence of late stent thrombosis was 1•7% at 1 year, The slope of the linear portion of the cumulative incidence curve between 30 days and 3 years indicated a steady rate of 0•6% per year. (figure )<ref name="pmid17321312">{{cite journal| author=Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C et al.| title=Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. | journal=Lancet | year= 2007 | volume= 369 | issue= 9562 | pages= 667-78 | pmid=17321312 | doi=10.1016/S0140-6736(07)60314-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17321312 }} </ref>
*The incidence of very late stent thrombosis more than 1 year after coronary revascularization is low, however [[drug-eluting stents]] appear to increase the risk for late thrombosis. In a meta-analysis of 14 trials analyzing 6675 patients, the incidence of very late thrombosis was 5.0 events per 1000 in drug-eluting stent patients and 5.9 events per 1000 incidence of very late thrombosis in paclitaxel stent patients. <ref name="pmid17145250">{{cite journal| author=Bavry AA, Kumbhani DJ, Helton TJ, Borek PP, Mood GR, Bhatt DL| title=Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials. | journal=Am J Med | year= 2006 | volume= 119 | issue= 12 | pages= 1056-61 | pmid=17145250 | doi=10.1016/j.amjmed.2006.01.023 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17145250 }} </ref>


In 1911 patients with DES, late ST rate was 0.6% with 100% follow up rate.<ref name="pmid16860022">{{cite journal| author=Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW et al.| title=Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. | journal=Am J Cardiol | year= 2006 | volume= 98 | issue= 3 | pages= 352-6 | pmid=16860022 | doi=10.1016/j.amjcard.2006.02.039 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16860022 }} </ref>
*A meta-analysis of 10 RCT involving 2602 patients with DES revealed a '''late''' ST rate of '''0.23%'''.<ref name="pmid15766835">{{cite journal| author=Moreno R, Fernández C, Hernández R, Alfonso F, Angiolillo DJ, Sabaté M et al.| title=Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 6 | pages= 954-9 | pmid=15766835 | doi=10.1016/j.jacc.2004.11.065 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15766835 }} </ref>


A late angiographic ST rate of 0.35% (95% confidence limits 0.17% to 0.72%).was reported in a cohort of 2006 patients with 98% of the patients being followed up. The rate from 1 month to 12 months was 0.25%.  If the patients who had premature cessation of antiplatelet therapy, then the incidence of late ST was 0.2%.<ref name="pmid15963413">{{cite journal| author=Ong AT, McFadden EP, Regar E, de Jaegere PP, van Domburg RT, Serruys PW| title=Late angiographic stent thrombosis (LAST) events with drug-eluting stents. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 12 | pages= 2088-92 | pmid=15963413 | doi=10.1016/j.jacc.2005.02.086 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15963413 }} </ref>
*In the real world setting a review of the e-cypher registry involving 15157 patients with [[sirolimus]], incidence of '''late''' ST was '''0.19%''' at 12months follow-up.<ref name="pmid16534015">{{cite journal| author=Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J et al.| title=Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. | journal=Circulation | year= 2006 | volume= 113 | issue= 11 | pages= 1434-41 | pmid=16534015 | doi=10.1161/CIRCULATIONAHA.104.532242 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16534015 }} </ref>


An incidence late ST of 0.7 % was reported in a meta-analysis of 19 RCT.<ref name="pmid16216853">{{cite journal| author=Roiron C, Sanchez P, Bouzamondo A, Lechat P, Montalescot G| title=Drug eluting stents: an updated meta-analysis of randomised controlled trials. | journal=Heart | year= 2006 | volume= 92 | issue= 5 | pages= 641-9 | pmid=16216853 | doi=10.1136/hrt.2005.061622 | pmc=PMC1860942 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16216853 }} </ref>
*In a study of serial angioscopy study of 17 patients with [[sirolimus]], 3 patients had visible thrombus at 21 months follow-up.<ref name="pmid17684153">{{cite journal| author=Awata M, Kotani J, Uematsu M, Morozumi T, Watanabe T, Onishi T et al.| title=Serial angioscopic evidence of incomplete neointimal coverage after sirolimus-eluting stent implantation: comparison with bare-metal stents. | journal=Circulation | year= 2007 | volume= 116 | issue= 8 | pages= 910-6 | pmid=17684153 | doi=10.1161/CIRCULATIONAHA.105.609057 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17684153 }} </ref>


In a real world setting in a study involving 15157 patients with SES rate of late ST was 0.19 with an acuturial 12 month rare of 0.87%.<ref name="pmid16534015">{{cite journal| author=Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J et al.| title=Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. | journal=Circulation | year= 2006 | volume= 113 | issue= 11 | pages= 1434-41 | pmid=16534015 | doi=10.1161/CIRCULATIONAHA.104.532242 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16534015  }} </ref>
===[[Sirolimus]] Eluting Stent(SES) vs [[Paclitaxel]] Eluting Stent(PES)===
It it not clear whether SES is better than PES as multiple studies demonstrate conflicting results.


The incidence for late ST in DES was 0.5% in a meta-analysis of 14 trials looking at 6675 patients.<ref name="pmid17145250">{{cite journal| author=Bavry AA, Kumbhani DJ, Helton TJ, Borek PP, Mood GR, Bhatt DL| title=Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials. | journal=Am J Med | year= 2006 | volume= 119 | issue= 12 | pages= 1056-61 | pmid=17145250 | doi=10.1016/j.amjmed.2006.01.023 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17145250 }} </ref>
*Study assessing 2 year outcomes in Western Denmark Heart Registry with patients implanted with SES and PES showed that the '''risk of developing ST with SES was lower'''. 2 year ST incidence with SES was 1.73% and 3.31% with PES.<ref name="pmid19232897">{{cite journal| author=Kaltoft A, Jensen LO, Maeng M, Tilsted HH, Thayssen P, Bøttcher M et al.| title=2-year clinical outcomes after implantation of sirolimus-eluting, paclitaxel-eluting, and bare-metal coronary stents: results from the WDHR (Western Denmark Heart Registry). | journal=J Am Coll Cardiol | year= 2009 | volume= 53 | issue= 8 | pages= 658-64 | pmid=19232897 | doi=10.1016/j.jacc.2008.09.058 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19232897 }} </ref>


A meta-analysis of 10 RCT involving 2602 patients with DES revealed a late ST rate of 0.23%.<ref name="pmid15766835">{{cite journal| author=Moreno R, Fernández C, Hernández R, Alfonso F, Angiolillo DJ, Sabaté M et al.| title=Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 6 | pages= 954-9 | pmid=15766835 | doi=10.1016/j.jacc.2004.11.065 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15766835 }} </ref>
*A meta-analysis of 878 patients treated with SES and 1400 treated with PES demonstrated that there was '''no difference in incidence rate(0.9%) of ST''' with SES compared to PES.<ref name="pmid17296821">{{cite journal| author=Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE| title=Stent thrombosis in randomized clinical trials of drug-eluting stents. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 10 | pages= 1020-9 | pmid=17296821 | doi=10.1056/NEJMoa067731 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17296821 }} </ref>


In the real world setting a review of the e-cypher registry involving 15157 patients with SES, rate of late ST was 0.19%.<ref name="pmid16534015">{{cite journal| author=Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J et al.| title=Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. | journal=Circulation | year= 2006 | volume= 113 | issue= 11 | pages= 1434-41 | pmid=16534015 | doi=10.1161/CIRCULATIONAHA.104.532242 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16534015 }} </ref>
*'''SORT OUT II''' randomized clinical trial with 2098 patients, compared the outcomes in patients implanted with SES and PES. It inferred that there were '''no significant differences in ST incidence rates''' between the two.<ref name="pmid18230778">{{cite journal| author=Galløe AM, Thuesen L, Kelbaek H, Thayssen P, Rasmussen K, Hansen PR et al.| title=Comparison of paclitaxel- and sirolimus-eluting stents in everyday clinical practice: the SORT OUT II randomized trial. | journal=JAMA | year= 2008 | volume= 299 | issue= 4 | pages= 409-16 | pmid=18230778 | doi=10.1001/jama.299.4.409 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18230778 }} </ref>


In a large observational study of more than 8000 patients with DES, the incidence of late stent thrombosis was 0.6%.  This accounted for 40% of total number of ST.<ref name="pmid17145250">{{cite journal| author=Bavry AA, Kumbhani DJ, Helton TJ, Borek PP, Mood GR, Bhatt DL| title=Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials. | journal=Am J Med | year= 2006 | volume= 119 | issue= 12 | pages= 1056-61 | pmid=17145250 | doi=10.1016/j.amjmed.2006.01.023 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17145250  }} </ref>
*'''Incidence of ST in PES patients was observed to be significantly higher''' than that in SES patients in a meta-analysis involving 18,023 patients.<ref name="pmid17869634">{{cite journal| author=Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC, Schömig A et al.| title=Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. | journal=Lancet | year= 2007 | volume= 370 | issue= 9591 | pages= 937-48 | pmid=17869634 | doi=10.1016/S0140-6736(07)61444-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17869634 }} </ref> This was re-emphasized by another meta-analysis involving 8,695 patients. However there were no significant differences in the mortality rate between the two. <ref name="pmid17903638">{{cite journal| author=Schömig A, Dibra A, Windecker S, Mehilli J, Suárez de Lezo J, Kaiser C et al.| title=A meta-analysis of 16 randomized trials of sirolimus-eluting stents versus paclitaxel-eluting stents in patients with coronary artery disease. | journal=J Am Coll Cardiol | year= 2007 | volume= 50 | issue= 14 | pages= 1373-80 | pmid=17903638 | doi=10.1016/j.jacc.2007.06.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17903638 }} </ref>
 
In an observational  study involving 4666 patients, the outcomes were assessed on the basis of antiplatelet use as reported by the patients. The landmark analysis at 12 months suggested the lowest mortality with those who had a DES and who were on dual antiplatelet therapy. How ever only 35% of the original cohort was analyzed at 12 months. (see figure below)
 
The real incidence of thrombus formation inside a SES was shown in an elegent angioscopy study where 3 out of 17 stents showed very late thrombus formation at 21.2±2.2 months.<ref name="pmid17684153">{{cite journal| author=Awata M, Kotani J, Uematsu M, Morozumi T, Watanabe T, Onishi T et al.| title=Serial angioscopic evidence of incomplete neointimal coverage after sirolimus-eluting stent implantation: comparison with bare-metal stents. | journal=Circulation | year= 2007 | volume= 116 | issue= 8 | pages= 910-6 | pmid=17684153 | doi=10.1161/CIRCULATIONAHA.105.609057 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17684153  }} </ref>
 
In the real world setting and with SES an annual rate of 0.87 % was reported up to 3 yrs of follow up.<ref name="pmid16534015">{{cite journal| author=Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J et al.| title=Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. | journal=Circulation | year= 2006 | volume= 113 | issue= 11 | pages= 1434-41 | pmid=16534015 | doi=10.1161/CIRCULATIONAHA.104.532242 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16534015  }} </ref>
 
In a large observational study of more than 8000 patients the cumulative incidence of very late stent thrombosis was 2•3% at 2 years, and 2•9% at 3 years. Late stent thrombosis occurred steadily at a constant rate of 0•6% per year up to 3 years after stent implantation with no evidence of diminution. 75% of patients were not followed up at three years and mortality data were taken from municipal registries. This process may have excluded some of the events. Therefore the number of events would have been higher than reported. (figure) <ref name="pmid17321312">{{cite journal| author=Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C et al.| title=Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. | journal=Lancet | year= 2007 | volume= 369 | issue= 9562 | pages= 667-78 | pmid=17321312 | doi=10.1016/S0140-6736(07)60314-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17321312 }} </ref>
 
The incidence for very late ST for DES was 0.5% and that for SES was 0.36% in a meta-analysis of 14 trials looking at 6675 patients. The risk of ST with DES remained constant up to the end of follow up period of 4 yrs.<ref name="pmid17145250">{{cite journal| author=Bavry AA, Kumbhani DJ, Helton TJ, Borek PP, Mood GR, Bhatt DL| title=Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials. | journal=Am J Med | year= 2006 | volume= 119 | issue= 12 | pages= 1056-61 | pmid=17145250 | doi=10.1016/j.amjmed.2006.01.023 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17145250  }} </ref>
 
In a cohort of 2006 patients with DES and with a 98% follow up rate, a very late ST rate was 0.15%.<ref name="pmid15963413">{{cite journal| author=Ong AT, McFadden EP, Regar E, de Jaegere PP, van Domburg RT, Serruys PW| title=Late angiographic stent thrombosis (LAST) events with drug-eluting stents. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 12 | pages= 2088-92 | pmid=15963413 | doi=10.1016/j.jacc.2005.02.086 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15963413  }} </ref>
 
In a study of serial angioscopy study of 17 patients with SES, 3 patients had visible thrombus at 21 months follow-up.<ref name="pmid17684153">{{cite journal| author=Awata M, Kotani J, Uematsu M, Morozumi T, Watanabe T, Onishi T et al.| title=Serial angioscopic evidence of incomplete neointimal coverage after sirolimus-eluting stent implantation: comparison with bare-metal stents. | journal=Circulation | year= 2007 | volume= 116 | issue= 8 | pages= 910-6 | pmid=17684153 | doi=10.1161/CIRCULATIONAHA.105.609057 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17684153 }} </ref>


==References==
==References==
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Latest revision as of 16:05, 5 March 2013

Coronary stent thrombosis Microchapters

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Introduction

Definition

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Relation to Bare Metal Stents
Relation to Drug Eluting Stents
Relation to Antiplatelet Medications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Smita Kohli, M.D.; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Overall lifetime incidence of stent thrombosis (ST) in patients with drug eluting stent(DES), from multiple trials is in the range of 0.5-2%. How ever there is wide variation of the incidence depending on the multiple variables which influence its occurrence.

Relation to Drug Eluting Stents

Incidence in Drug Eluting Stents

  • In a study of 3548 registry patients who received a DES, the cumulative incidence of definite, probable or possible ST was 1.8%. The incidence for definite ST was 0.65% over a 15 month period.[1]
  • In a study of 1911 patients with DES and a follow up to a median 19.4 months , the overall incidence of ST was 0.8%.[2]
  • In a study of 1731 patients undergoing sirolimus eluting stent(SES) implantation the cumulative one year ST rate was 1.7%. This number was 3.2% for diabetics.[3]
  • In a “real world” observational study involving 15157 patients with SES acturial incidence of ST at 12 months was 0.87%.[4]

Incidence of Early Stent Thrombosis with Drug Eluting Stents

This group would include

  1. Intra-procedural ST
  2. Acute ST: up to 24 hrs
  3. Subacute ST: 24 hrs to 30 days
  • Intra-procedural ST occurred in 0.7% of patients in a study of 670 patients with 1362 lesions who received a SES. The average stent length was 42.9 ± 28.3 mm.[5]
  • A rate of 0.5% of acute ST was observed in a study of 1911 patients who were treated with aspirin, clopidogrel and on the discretion of the treating physician.[2]
  • A meta-analysis of 10 RCT involving 2602 patientes who received a DES, showed a ST rate of 0.34% by 30th day.[6]
  • In the real world setting a review of the e-cypher registry involving 15157 patients with SES, rate of sub-acute ST was 0.56%.[4]
  • An incidence subacute ST of 0.83 % was reported in a meta-analysis of 19 randomised controlled trails.[7]
  • In a large observational study of more than 8000 patients with DES, the cumulative incidence of subacute stent thrombosis was 1.1% at 30 days. This accounted for 60% of total ST.[8]

Incidence of Late Stent Thrombosis with Drug Eluting Stent

This would include

  1. Late ST: 30 days to one year
  2. Very late ST: more than one year, but generally less than 3 years
  3. Later than 3 years
  • In a study of more than 8146 patients in two academic centers, the cumulative incidence of late stent thrombosis was 1.7% at 1 year. The slope of the linear portion of the cumulative incidence curve between 30 days and 3 years indicated a steady rate of 0.6% per year.[8] Late stent thrombosis was more frequent with PES (1.8%) than with SES (1.4%). 23% of patients who developed late ST were being treated with dual antiplatelet therapy. This study concluded that late stent thrombosis was encountered steadily with no evidence of diminution up to 3 years of follow-up. Cumulative incidence of very late stent thrombosis was 2.3% at 2 years, and 2.9% at 3 years
  • A late angiographic ST rate of 0.35% (95% confidence limits 0.17% to 0.72%) was reported in a cohort of 2006 patients with 98% of the patients being followed up. The incidence of ST between 30 days to 1 year was 0.25% and incidence of very late ST was 0.15%. Also concluded that ST may occur even if the patients are stable on antiplatelet monotherapy.[9]
  • An incidence late ST of 0.7 % was reported in a meta-analysis of 19 RCT.[7]
  • The incidence of very late stent thrombosis more than 1 year after coronary revascularization is low, however drug-eluting stents appear to increase the risk for late thrombosis. In a meta-analysis of 14 trials analyzing 6675 patients, the incidence of very late thrombosis was 5.0 events per 1000 in drug-eluting stent patients and 5.9 events per 1000 incidence of very late thrombosis in paclitaxel stent patients. [10]
  • A meta-analysis of 10 RCT involving 2602 patients with DES revealed a late ST rate of 0.23%.[6]
  • In the real world setting a review of the e-cypher registry involving 15157 patients with sirolimus, incidence of late ST was 0.19% at 12months follow-up.[4]
  • In a study of serial angioscopy study of 17 patients with sirolimus, 3 patients had visible thrombus at 21 months follow-up.[11]

Sirolimus Eluting Stent(SES) vs Paclitaxel Eluting Stent(PES)

It it not clear whether SES is better than PES as multiple studies demonstrate conflicting results.

  • Study assessing 2 year outcomes in Western Denmark Heart Registry with patients implanted with SES and PES showed that the risk of developing ST with SES was lower. 2 year ST incidence with SES was 1.73% and 3.31% with PES.[12]
  • A meta-analysis of 878 patients treated with SES and 1400 treated with PES demonstrated that there was no difference in incidence rate(0.9%) of ST with SES compared to PES.[13]
  • SORT OUT II randomized clinical trial with 2098 patients, compared the outcomes in patients implanted with SES and PES. It inferred that there were no significant differences in ST incidence rates between the two.[14]
  • Incidence of ST in PES patients was observed to be significantly higher than that in SES patients in a meta-analysis involving 18,023 patients.[15] This was re-emphasized by another meta-analysis involving 8,695 patients. However there were no significant differences in the mortality rate between the two. [16]

References

  1. ↑ Jensen LO, Maeng M, Kaltoft A, Thayssen P, Hansen HH, Bottcher M; et al. (2007). "Stent thrombosis, myocardial infarction, and death after drug-eluting and bare-metal stent coronary interventions". J Am Coll Cardiol. 50 (5): 463–70. doi:10.1016/j.jacc.2007.06.002. PMID 17662400.
  2. ↑ 2.0 2.1 2.2 Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW; et al. (2006). "Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up". Am J Cardiol. 98 (3): 352–6. doi:10.1016/j.amjcard.2006.02.039. PMID 16860022.
  3. ↑ Machecourt J, Danchin N, Lablanche JM, Fauvel JM, Bonnet JL, Marliere S; et al. (2007). "Risk factors for stent thrombosis after implantation of sirolimus-eluting stents in diabetic and nondiabetic patients: the EVASTENT Matched-Cohort Registry". J Am Coll Cardiol. 50 (6): 501–8. doi:10.1016/j.jacc.2007.04.051. PMID 17678732.
  4. ↑ 4.0 4.1 4.2 Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J; et al. (2006). "Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry". Circulation. 113 (11): 1434–41. doi:10.1161/CIRCULATIONAHA.104.532242. PMID 16534015.
  5. ↑ Chieffo A, Bonizzoni E, Orlic D, Stankovic G, Rogacka R, Airoldi F; et al. (2004). "Intraprocedural stent thrombosis during implantation of sirolimus-eluting stents". Circulation. 109 (22): 2732–6. doi:10.1161/01.CIR.0000131890.83839.5B. PMID 15148281.
  6. ↑ 6.0 6.1 Moreno R, Fernández C, Hernández R, Alfonso F, Angiolillo DJ, Sabaté M; et al. (2005). "Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies". J Am Coll Cardiol. 45 (6): 954–9. doi:10.1016/j.jacc.2004.11.065. PMID 15766835.
  7. ↑ 7.0 7.1 Roiron C, Sanchez P, Bouzamondo A, Lechat P, Montalescot G (2006). "Drug eluting stents: an updated meta-analysis of randomised controlled trials". Heart. 92 (5): 641–9. doi:10.1136/hrt.2005.061622. PMC 1860942. PMID 16216853.
  8. ↑ 8.0 8.1 Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C; et al. (2007). "Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study". Lancet. 369 (9562): 667–78. doi:10.1016/S0140-6736(07)60314-6. PMID 17321312.
  9. ↑ Ong AT, McFadden EP, Regar E, de Jaegere PP, van Domburg RT, Serruys PW (2005). "Late angiographic stent thrombosis (LAST) events with drug-eluting stents". J Am Coll Cardiol. 45 (12): 2088–92. doi:10.1016/j.jacc.2005.02.086. PMID 15963413.
  10. ↑ Bavry AA, Kumbhani DJ, Helton TJ, Borek PP, Mood GR, Bhatt DL (2006). "Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials". Am J Med. 119 (12): 1056–61. doi:10.1016/j.amjmed.2006.01.023. PMID 17145250.
  11. ↑ Awata M, Kotani J, Uematsu M, Morozumi T, Watanabe T, Onishi T; et al. (2007). "Serial angioscopic evidence of incomplete neointimal coverage after sirolimus-eluting stent implantation: comparison with bare-metal stents". Circulation. 116 (8): 910–6. doi:10.1161/CIRCULATIONAHA.105.609057. PMID 17684153.
  12. ↑ Kaltoft A, Jensen LO, Maeng M, Tilsted HH, Thayssen P, Bøttcher M; et al. (2009). "2-year clinical outcomes after implantation of sirolimus-eluting, paclitaxel-eluting, and bare-metal coronary stents: results from the WDHR (Western Denmark Heart Registry)". J Am Coll Cardiol. 53 (8): 658–64. doi:10.1016/j.jacc.2008.09.058. PMID 19232897.
  13. ↑ Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE (2007). "Stent thrombosis in randomized clinical trials of drug-eluting stents". N Engl J Med. 356 (10): 1020–9. doi:10.1056/NEJMoa067731. PMID 17296821.
  14. ↑ Galløe AM, Thuesen L, Kelbaek H, Thayssen P, Rasmussen K, Hansen PR; et al. (2008). "Comparison of paclitaxel- and sirolimus-eluting stents in everyday clinical practice: the SORT OUT II randomized trial". JAMA. 299 (4): 409–16. doi:10.1001/jama.299.4.409. PMID 18230778.
  15. ↑ Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC, Schömig A; et al. (2007). "Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis". Lancet. 370 (9591): 937–48. doi:10.1016/S0140-6736(07)61444-5. PMID 17869634.
  16. ↑ Schömig A, Dibra A, Windecker S, Mehilli J, Suárez de Lezo J, Kaiser C; et al. (2007). "A meta-analysis of 16 randomized trials of sirolimus-eluting stents versus paclitaxel-eluting stents in patients with coronary artery disease". J Am Coll Cardiol. 50 (14): 1373–80. doi:10.1016/j.jacc.2007.06.047. PMID 17903638.


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