Stent Thrombosis and New-Generation DES in Primary PCI
Stent Thrombosis and New-Generation DES in Primary PCI
Background Some concerns still have not been resolved about the long-term safety of drug-eluting stents (DES) in patients with acute STEMI.
Objectives The aim of this study was to evaluate the stent thrombosis (ST) rate up to 3 years in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (n-DES) compared with bare-metal stents (BMS) and old-generation drug-eluting stents (o-DES) enrolled in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry).
Methods From January 2007 to January 2013, 34,147 patients with STEMI were treated by PCI with n-DES (n = 4,811), o-DES (n = 4,271), or BMS (n = 25,065). The risks of early/late (up to 1 year) and very late definite ST (after 1 year) were estimated.
Results Cox regression landmark analysis showed a significantly lower risk of early/late ST in patients treated with n-DES (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.99; p = 0.04) and o-DES (HR: 0.60; 95% CI: 0.41 to 0.89; p = 0.01) compared with the BMS group. The risk of very late ST was similar between the n-DES and BMS groups (HR: 1.52; 95% CI: 0.78 to 2.98; p = 0.21), whereas a higher risk of very late ST was observed with o-DES compared with BMS (HR: 2.88; 95% CI: 1.70 to 4.89; p < 0.01).
Conclusions Patients treated with n-DES have a lower risk of early/late ST than patients treated with BMS. The risk of very late ST is low and comparable between n-DES and BMS up to 3 years of follow-up, whereas o-DES treatment is associated with an increased risk of very late ST. The current STEMI guidelines might require an update in light of the results of this and other recent studies.
Drug-eluting stents (DES) have been shown to significantly reduce the rate of restenosis and target lesion revascularization, and consequently, their use has been commonly extended to complex lesions and acute clinical settings. Concerns have been raised and still not resolved about the long-term safety of DES in patients with acute ST-segment elevation myocardial infarction (STEMI).
Platelet activation is increased in patients with STEMI. Moreover, a delay in arterial healing has been recognized at the culprit site in patients with STEMI compared with patients treated for stable angina. Percutaneous coronary intervention (PCI) in STEMI patients is therefore associated with a higher risk of stent thrombosis (ST).
Comparisons of new-generation DES (n-DES) and bare-metal stents (BMS) in the STEMI setting are limited. The available data on the outcome of PCI in STEMI patients are mainly based on comparisons of old-generation DES (o-DES) and BMS.
The objective of this study was to evaluate the ST rate up to 3 years in patients with STEMI treated by PCI with n-DES compared with BMS and o-DES documented in a national registry with complete consecutive enrollment, the SCAAR (Swedish Coronary Angiography and Angioplasty Registry).
Abstract and Introduction
Abstract
Background Some concerns still have not been resolved about the long-term safety of drug-eluting stents (DES) in patients with acute STEMI.
Objectives The aim of this study was to evaluate the stent thrombosis (ST) rate up to 3 years in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (n-DES) compared with bare-metal stents (BMS) and old-generation drug-eluting stents (o-DES) enrolled in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry).
Methods From January 2007 to January 2013, 34,147 patients with STEMI were treated by PCI with n-DES (n = 4,811), o-DES (n = 4,271), or BMS (n = 25,065). The risks of early/late (up to 1 year) and very late definite ST (after 1 year) were estimated.
Results Cox regression landmark analysis showed a significantly lower risk of early/late ST in patients treated with n-DES (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.99; p = 0.04) and o-DES (HR: 0.60; 95% CI: 0.41 to 0.89; p = 0.01) compared with the BMS group. The risk of very late ST was similar between the n-DES and BMS groups (HR: 1.52; 95% CI: 0.78 to 2.98; p = 0.21), whereas a higher risk of very late ST was observed with o-DES compared with BMS (HR: 2.88; 95% CI: 1.70 to 4.89; p < 0.01).
Conclusions Patients treated with n-DES have a lower risk of early/late ST than patients treated with BMS. The risk of very late ST is low and comparable between n-DES and BMS up to 3 years of follow-up, whereas o-DES treatment is associated with an increased risk of very late ST. The current STEMI guidelines might require an update in light of the results of this and other recent studies.
Introduction
Drug-eluting stents (DES) have been shown to significantly reduce the rate of restenosis and target lesion revascularization, and consequently, their use has been commonly extended to complex lesions and acute clinical settings. Concerns have been raised and still not resolved about the long-term safety of DES in patients with acute ST-segment elevation myocardial infarction (STEMI).
Platelet activation is increased in patients with STEMI. Moreover, a delay in arterial healing has been recognized at the culprit site in patients with STEMI compared with patients treated for stable angina. Percutaneous coronary intervention (PCI) in STEMI patients is therefore associated with a higher risk of stent thrombosis (ST).
Comparisons of new-generation DES (n-DES) and bare-metal stents (BMS) in the STEMI setting are limited. The available data on the outcome of PCI in STEMI patients are mainly based on comparisons of old-generation DES (o-DES) and BMS.
The objective of this study was to evaluate the ST rate up to 3 years in patients with STEMI treated by PCI with n-DES compared with BMS and o-DES documented in a national registry with complete consecutive enrollment, the SCAAR (Swedish Coronary Angiography and Angioplasty Registry).