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.
BACKGROUND
Stent thrombosis is a safety concern associated with use of drug-eluting stents. Little is known about occurrence of stent thrombosis more than 1 year after implantation of such stents.


METHODS
Between April, 2002, and Dec, 2005, 8146 patients underwent percutaneous coronary intervention with sirolimus-eluting stents (SES; n=3823) or paclitaxel-eluting stents (PES; n=4323) at two academic hospitals. We assessed data from this group to ascertain the incidence, time course, and correlates of stent thrombosis, and the differences between early (0-30 days) and late (>30 days) stent thrombosis and between SES and PES.


RESULTS
Angiographically documented stent thrombosis occurred in 152 patients (incidence density 1.3 per 100 person-years; cumulative incidence at 3 years 2.9%). Early stent thrombosis was noted in 91 (60%) patients, and late stent thrombosis in 61 (40%) patients. Late stent thrombosis occurred steadily at a constant rate of 0.6% per year up to 3 years after stent implantation. Incidence of early stent thrombosis was similar for SES (1.1%) and PES (1.3%), but late stent thrombosis was more frequent with PES (1.8%) than with SES (1.4%; p=0.031). At the time of stent thrombosis, dual antiplatelet therapy was being taken by 87% (early) and 23% (late) of patients (p<0.0001). Independent predictors of overall stent thrombosis were acute coronary syndrome at presentation (hazard ratio 2.28, 95% CI 1.29-4.03) and diabetes (2.03, 1.07-3.83).


CONCLUSIONS
Late stent thrombosis was encountered steadily with no evidence of diminution up to 3 years of follow-up. Early and late stent thrombosis were observed with SES and with PES. Acute coronary syndrome at presentation and diabetes were independent predictors of stent thrombosis.
Daemen
Joost
J
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr Molewaterplein 40,3015 GD Rotterdam, Netherlands.
Wenaweser
Peter
P
Tsuchida
Keiichi
K
Abrecht
Linda
L
Vaina
Sophia
S
Morger
Cyrill
C
Kukreja
Neville
N
Jüni
Peter
P
Sianos
Georgios
G
Hellige
Gerrit
G
van Domburg
Ron T
RT
Hess
Otto M
OM
Boersma
Eric
E
Meier
Bernhard
B
Windecker
Stephan
S
Serruys
Patrick W
PW
D015906:Angioplasty, Balloon, Coronary; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003328:Coronary Thrombosis / Q000150:complications / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D017239:Paclitaxel / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects*; D016019:Survival Analysis; D013997:Time Factors
D000900:Anti-Bacterial Agents; D017239:Paclitaxel; D020123:Sirolimus