title: Stent thrombosis in early-generation drug-eluting stents versus newer-generation everolimus-eluting stent assorted by LVEF.
abstract: OBJECTIVE
  Everolimus drug-eluting stents (EES) are superior to early-generation drug-eluting stents (DES), releasing sirolimus (SES) or paclitaxel (PES) in preventing stent thrombosis (ST). Since an impaired LVEF seems to increase the risk of ST, we aimed to investigate the difference in outcome of patients with varying LVEF using EES versus early-generation DES.
  
  
  METHODS
  In a prospective cohort study, we compared the risk of ST in patients in three LVEF subgroups: normal (LVEF >50%), mildly impaired (LVEF >40% and ≤50%) and moderate-severely impaired (LVEF ≤40%). Within these various LVEF groups, we compared EES with SES and PES after adjustment for baseline differences.
  
  
  RESULTS
  We assessed a cohort of 5363 patients, with follow-up of up to 4 years and available LVEF. Overall definite ST occurred in 123 (2.3%) patients. ST rates were higher in the LVEF moderate-severely impaired group compared with the normal LVEF group (2.8% vs 2.1%; HR 1.82; CI 1.10 to 3.00). Especially early ST (EST) was more frequent in the moderate-severely impaired LVEF group (HR 2.20; CI 1.06 to 4.53). Overall rates of definite ST were lower in patients using EES compared with patients using SES or PES in all LVEF groups. Interaction terms were not statistically significant. ST rates were higher in the moderate-severely impaired LVEF group compared with the normal LVEF group when using SES or PES, but not significantly different when using EES.
  
  
  CONCLUSIONS
  EES was associated with a lower risk of definite ST compared with early-generation DES. This lower risk was independent of LVEF, even though ST rates were higher in patients with a moderate-severely impaired LVEF.
  
  
  BACKGROUND
  MEC-2013-262.
authors.affiliation: Department of Cardiology, Medical Centre Alkmaar, Alkmaar, The Netherlands Cardiovascular Research School (COEUR), Erasmus university, Rotterdam, The Netherlands.
authors.forename: Nick
authors.initials: N
authors.lastname: van Boven
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Department of Cardiology, Medical Centre Alkmaar, Alkmaar, The Netherlands.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Umans
authors.affiliation: Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.affiliation: Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Isabella
authors.initials: I
authors.lastname: Kardys
authors.affiliation: Erasmus MC, Rotterdam, The Netherlands.
authors.forename: K Martijn
authors.initials: KM
authors.lastname: Akkerhuis
authors.affiliation: Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Robbert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.affiliation: Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Magro
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.affiliation: Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
mesh_terms: D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D054855:Drug-Eluting Stents; D000068338:Everolimus; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013318:Stroke Volume; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016277:Ventricular Function, Left
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; D020123:Sirolimus