Very Late Stent Thrombosis and Late Target Lesion Revascularization After Sirolimus-Eluting Stent Implantation
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Open Access
- 31 January 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 125 (4), 584-591
- https://doi.org/10.1161/circulationaha.111.046599
Abstract
Background—: There is a scarcity of long-term data from large-scale drug-eluting stent registries with a large enough sample to evaluate low-frequency events such as stent thrombosis (ST). Methods and Results—: Five-year outcomes were evaluated in 12 812 consecutive patients undergoing sirolimus-eluting stent (SES) implantation in the j-Cypher registry. Cumulative incidence of definite ST was low (30 day, 0.3%; 1 year, 0.6%; and 5 years, 1.6%). However, late and very late ST continued to occur without attenuation up to 5 years after sirolimus-eluting stent implantation (0.26%/y). Cumulative incidence of target lesion revascularization within the first year was low (7.3%). However, late target lesion revascularization beyond 1 year also continued to occur without attenuation up to 5 years (2.2%/y). Independent risk factors of ST were completely different according to the timing of ST onset, suggesting the presence of different pathophysiological mechanisms of ST according to the timing of ST onset: acute coronary syndrome and target of proximal left anterior descending coronary artery for early ST; side-branch stenting, diabetes mellitus, and end-stage renal disease with or without hemodialysis for late ST; and current smoking and total stent length >28 mm for very late ST. Independent risk factors of late target lesion revascularization beyond 1 year were generally similar to those risk factors identified for early target lesion revascularization. Conclusion—: Late adverse events such as very late ST and late target lesion revascularization are continuous hazards, lasting at least up to 5 years after implantation of the first-generation drug-eluting stents (sirolimus-eluting stents), which should be the targets for developing improved coronary stents.This publication has 16 references indexed in Scilit:
- Very Long-Term (15 to 20 Years) Clinical and Angiographic Outcome After Coronary Bare Metal Stent ImplantationCirculation: Cardiovascular Interventions, 2010
- Incidence and Risk Factors of Late Target Lesion Revascularization After Sirolimus-Eluting Stent Implantation (3-Year Follow-Up of the j-Cypher Registry)The American Journal of Cardiology, 2010
- 5-Year Clinical Outcomes After Sirolimus-Eluting Stent Implantation: Insights From a Patient-Level Pooled Analysis of 4 Randomized Trials Comparing Sirolimus-Eluting Stents With Bare-Metal StentsJournal of the American College of Cardiology, 2009
- Safety and Efficacy of Drug-Eluting and Bare Metal StentsCirculation, 2009
- Use of Drug-Eluting Stents in Acute Myocardial Infarction: A Systematic Review and Meta-AnalysisJournal of the American College of Cardiology, 2009
- Antiplatelet Therapy and Stent Thrombosis After Sirolimus-Eluting Stent ImplantationCirculation, 2009
- Incidence and Correlates of Drug-Eluting Stent Thrombosis in Routine Clinical Practice: 4-Year Results From a Large 2-Institutional Cohort StudyJournal of the American College of Cardiology, 2008
- Stent Thrombosis in Randomized Clinical Trials of Drug-Eluting StentsThe New England Journal of Medicine, 2007
- Five-Year Outcomes After Coronary Stenting Versus Bypass Surgery for the Treatment of Multivessel Disease: The Final Analysis of the Arterial Revascularization Therapies Study (ARTS) Randomized TrialJournal of the American College of Cardiology, 2005
- Estimation of failure probabilities in the presence of competing risks: new representations of old estimatorsStatistics in Medicine, 1999