Coronary artery diseaseRates of Stent Thrombosis in Bare-Metal Versus Drug-Eluting Stents (from a Large Australian Multicenter Registry)
Section snippets
Methods
The study population consisted of patients with 2,919 percutaneous coronary interventions with stent implantation in 3,583 lesions from the Melbourne Interventional Group registry (April 1, 2004, to October 10, 2006). The DES group had ≥1 DES used, and the bare-metal stent (BMS) group had only BMSs implanted.
The registry is a voluntary collaborative venture of interventional cardiologists practicing at 7 Australian public (government-funded) hospitals designed to record data pertaining to
Results
Of patients with 2,919 percutaneous coronary interventions with stent implantation, 1,630 patients (55.8%) received ≥1 DES, and 1,289 patients (44.2%) received only BMSs (Table 1). In the DES cohort, both DESs and BMSs were implanted in 8.7% of patients (n = 142) and 1.2% (n = 42) of lesions. Patients who received a DES compared with a BMS were older (65.4 ± 11.9 vs 64.4 ± 12.0 years; p <0.02), less likely to be current smokers (18.2% vs 25.6%; p <0.01), more likely to have diabetes (29.6% vs
Discussion
The principal findings of this large Australian registry that selectively used DESs for patients at high risk of restenosis included (1) low (1.5%) overall ST rates after DES implantation; (2) DESs were not associated with increased risk of ST, mortality, or myocardial infarction compared with BMSs; (3) target-vessel revascularization and MACE rates were low and similar between the DES and BMS groups; (4) planned duration of clopidogrel therapy was longer in patients who received a DES compared
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Incidence, Predictors and Clinical Outcomes of Stent Thrombosis Following Percutaneous Coronary Intervention in Contemporary Practice
2020, Heart Lung and CirculationCitation Excerpt :Stent thrombosis (ST) is an uncommon but serious complication of percutaneous coronary intervention (PCI) [1], most frequently occurring within 30 days of the procedure [2]. Despite recent advances in stent implantation technologies and improvements in adjuvant antiplatelet therapy, the rate of ST with second and third generation drug eluting stents (DES) ranges from 0.5 to 1% and carries a mortality rate of 20–30%, with death often due to myocardial infarction [3–6]. Though a low incidence of ST has previously limited characterisation of specific risk factors, multiple observational studies have reported several clinical and procedural predictors for ST following PCI [1,4,7–11].
Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention
2014, International Journal of CardiologyCitation Excerpt :It has been reported that off-pump CABG may be advantageous in patients with renal impairment, but its longer term benefit is controversial and it was used infrequently in our study [50,51]. Conversely, renal impairment has emerged as a risk factor for late stent thrombosis with both bare-metal and drug-eluting stents, in spite of high rates of antiplatelet therapy, as previously reported by us and other PCI registries [52–54]. We have compared two registries and it is likely that selection bias will affect which patients receive PCI compared to CABG.
Incidence and predictors of coronary stent thrombosis: Evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses
2013, International Journal of CardiologyCitation Excerpt :Indeed, assuming recent estimates hold true, the patient population included in our meta-analysis exceeds the number of patients undergoing PCI in any single large European country yearly. Moreover, in order to provide a real-world perspective on coronary stenting, we considered studies involving both BMS and DES [79]. Whereas some cardiologists have advocated in the past an almost universal adoption of DES, and despite their evident benefits on restenosis, BMS remain commonly used, especially in patients less likely to comply with a prolonged dual antiplatelet regime, and they should not be viewed as obsolete, in Europe as well as North America [80].
Coronary Artery Bypass Surgery Provides Long-Term Results Superior to Percutaneous Coronary Intervention
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The Melbourne Interventional Group was supported by Astra-Zeneca, Biotronik, Boston-Scientific, Johnson & Johnson, Medtronic, Pfizer, Schering-Plough, Sanofi-Aventis, Servier, St Jude, and Terumo. These companies do not have access to the data and do not have the right to review articles before publication. Dr. Duffy was supported by an NHMRC Centre of Clinical Research Excellence grant to the Alfred and Baker Medical Unit.