Very Late Coronary Stent Thrombosis of a Newer Generation Everolimus-Eluting Stent Compared with Early Generation Drug-Eluting Stents: A Prospective Cohort Study
Background—Early generation drug-eluting stents (DES) releasing sirolimus (SES) or paclitaxel (PES) are associated with increased risk of very late stent thrombosis (VLST) occurring >1 year after stent implantation. It is unknown whether the risk of VLST persists with newer generation everolimus-eluting stents (EES).
Methods and Results—We assessed the risk of ST in a cohort of 12,339 patients with unrestricted use of DES (3,819 SES, 4,308 PES, 4,212 EES). Results are incidence rates (IR) per 100 person-years (PY) after inverse probability of treatment weighting to adjust for group differences. During follow-up to 4 years, the overall IR of definite ST was lower with EES (1.4 per 100 PY) compared with SES (2.9, HR 0.41, 95%-CI 0.27-0.62, p<0.0001) and PES (4.4, HR 0.33, 95%-CI 0.23-0.48, p<0.0001). The IR per 100 PY of early (0-30 days), late (31 days to 1 year), and VLST amounted to 0.6, 0.1, and 0.6 among EES, 1.0, 0.3, and 1.6 among SES, and 1.3, 0.7, and 2.4 among PES treated patients. Differences in favor of EES were most pronounced beyond 1 year, with HR of 0.33 (EES vs SES p=0.006) and 0.34 (EES vs PES p<0.0001). There was a lower risk of cardiac death or MI with EES compared with PES (HR 0.65, 95%-CI 0.56-0.75, p<0.0001), which was directly related to the lower risk of ST associated events (EES vs. PES: HR 0.36, 95%-CI 0.23-0.57).
Conclusions—Current treatment with EES is associated with lower risk of VLST compared with early generation DES.
- Received July 27, 2011.
- Accepted December 28, 2011.
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