Stent thrombosis, myocardial infarction, and death after drug-eluting and bare-metal stent coronary interventions.
OBJECTIVE
The aim of the study was to examine outcomes subsequent to implantation of drug-eluting stents (DES) and bare-metal stents (BMS).


BACKGROUND
Use of DES might be associated with increased risk of stent thrombosis (ST), myocardial infarction (MI), and death.


METHODS
From January 2002 through June 2005, data from all percutaneous coronary interventions in western Denmark were prospectively recorded in the Western Denmark Heart Registry; 12,395 consecutive patients (17,152 lesions) treated with stent implantation were followed for 15 months. Data on death and MI were ascertained from the national databases. The Academic Research Consortium definition of ST was used.


RESULTS
The DES were implanted in 3,548 patients (5,422 lesions) and BMS were implanted in 8,847 patients (11,730 lesions). Definite, probable, or possible ST was found in 190 (2.15%) patients in the BMS group and in 64 (1.80%) patients in the DES. The risk of definite ST was similar in the 2 groups (DES: 0.65%; BMS: 0.61%). Very late definite ST (between 12 and 15 months after implantation) occurred more frequently in patients receiving DES (hazard ratio [HR] 10.93, 95% confidence interval [CI] 1.27 to 93.76). Also, the risk of MI between 12 and 15 months after implantation was higher in the DES group (HR 4.00, 95% CI 2.06 to 7.79). Mortality was similar in the 2 groups. Target lesion revascularization was reduced by 43% in patients treated with DES (HR 0.57, 95% CI 0.48 to 0.67).


CONCLUSIONS
The minor risk of ST and MI within 15 months after implantation of DES seems unlikely to outweigh the benefit of these stents.
Department of Cardiology, Odense University Hospital, Odense, Denmark. okkels@dadlnet.dk
Lisette Okkels
LO
Jensen
Michael
M
Maeng
Anne
A
Kaltoft
Per
P
Thayssen
Hans Henrik Tilsted
HH
Hansen
Morten
M
Bottcher
Jens Flensted
JF
Lassen
Lars Romer
LR
Krussel
Klaus
K
Rasmussen
Knud Noerregaard
KN
Hansen
Lars
L
Pedersen
Soeren Paaske
SP
Johnsen
Henrik Toft
HT
Soerensen
Leif
L
Thuesen
D000368:Aged; D015984:Causality; D002423:Cause of Death; D015897:Comorbidity; D003328:Coronary Thrombosis / Q000453:epidemiology*; D003718:Denmark / Q000453:epidemiology; D016503:Drug Delivery Systems / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects* / Q000706:statistics & numerical data*