acronym)Trial-ClinicalTrialResults.pptVIP

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 Drug-eluting stents (DES) significantly reduce rates of restenosis and target lesion revascularization compared with bare metal stents (BMS). Since the publication of randomized trials on the two FDA approved DES, sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES), these devices have been widely used. However, several safety concerns have since been expressed, including concern about stent thrombosis. Little is known about occurrence of stent thrombosis more than one year after implantation of DES. At the time of ST, dual antiplatelet therapy was being taken by 87% (early) and 23% (late) of patients, p 0.0001. Independent predictors of overall ST were acute coronary syndrome at presentation (hazard ratio 2.28, 95% CI 1.29-4.03) and diabetes (HR 2.03, 95% CI 1.07-3.83). This was a non-randomized cohort study that was observational in nature, thus possibly disadvantaged by confounding by indication. PES were available for commercial use 1 year later than were SES, and the difference in follow up may have biased results. The data estimate the incidence of stent thrombosis after DES implantation during routine clinical practice at two tertiary care centers, so findings may not apply to institutions with more restricted use of DES. Only angiographically documented cases of stent thrombosis were counted, which might have underrepresented the actual incidence of stent thrombosis. The data suggest that late stent thrombosis occurs at a steady rate during follow-up up to three years, tends to be more frequent with PES than with SES, and can unpredictably occur at any time point despite antiplatelet therapy. Late stent thrombosis complicating the use of DES seems to be a distinct entity with pathophysiological factors that differ from those of early stent thrombosis. Clinical Tri