Abstract 17174: Predictors of Stent Thrombosis after Everolimus-Eluting and Paclitaxel-Eluting Stents: The Pooled SPIRIT Randomized Trial Experience at Two Years of Follow-Up
Background: Stent thrombosis (ST) is a devastating consequence of stent implantation. We sought to identify predictors of ST from a large cohort of patients treated with contemporary drug-eluting stents.
Methods: Data were pooled from the SPIRIT II, III, and IV randomized trials of the Xience V everolimus-eluting stent (EES) vs. the Taxus Express paclitaxel-eluting stent (PES). ST was adjudicated according to ARC definitions, and multivariable logistic regression was used to assess independent predictors of ST. Current data to 1 year is provided herein; 2-year data will be available at the time of presentation.
Results: A total of 4988 patients were included, with 31 definite/probable ST events occurring at one year. Of these events, 17 were early ST (less than 30 days), and 14 were late ST (30 days to one year). Independent baseline clinical and angiographic predictors of overall 1-year ST included: smoking, diabetes, presence of a side branch >=2 mm, LAD target vessel, prior MI, angina severity and randomization to PES. In a model including procedural factors as well, the use of bailout stents and treatment of >=2 lesions were the only additional factors associated with ST. Early ST was associated with baseline as well as procedural factors including smoking, LAD target vessel, number of stents implanted, randomization to PES and maximal balloon pressure. In contrast, late ST at one year was solely related to baseline factors including current smoking, presence of side branch >=2mm, and diabetes. Randomization to EES was protective from overall 1-year ST in both the baseline and full models. Two-year data will be available at the time of presentation and models will be re-run with this additional data.
Conclusions: In a pooled analysis from the SPIRIT trials, baseline rather than procedural factors best predicted overall ST, and especially late ST to one year. Randomization to EES was an independent predictor of freedom from one year ST. Two-year data will be presented, and will provide further insights into the long-term safety of EES and PES.
- © 2010 by American Heart Association, Inc.