title: Stent thrombosis in new-generation drug-eluting stents in patients with STEMI undergoing primary PCI: a report from SCAAR.
abstract: BACKGROUND
  Some concerns still have not been resolved about the long-term safety of drug-eluting stents (DES) in patients with acute STEMI.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. Electronic address: giovanna.sarno@ucr.uu.se.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Sarno
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
authors.affiliation: Department of Cardiology, Umea University Hospital, Heart Centre, Umea, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Nilsson
authors.affiliation: Department of Cardiology, Orebro University Hospital, Orebro, Sweden.
authors.forename: Ole
authors.initials: O
authors.lastname: Frobert
authors.affiliation: Department of Cardiology, Falun Hospital, Falun, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Hambraeus
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Christoph
authors.initials: C
authors.lastname: Varenhorst
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ulf J
authors.initials: UJ
authors.lastname: Jensen
authors.affiliation: Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Tim
authors.initials: T
authors.lastname: Tödt
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden.
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000639:trends; D017023:Coronary Angiography / Q000639:trends; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000639:trends*; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
keywords: ST-segment elevation myocardial infarction; drug-eluting stent(s); percutaneous coronary intervention