Contemporary Incidence and Predictors of Stent Thrombosis and Other Major Adverse Cardiac Events in the Year After XIENCE V Implantation

S tent thrombosis (ST) is an uncommon but catastrophic complication following stent implantation associated with a high incidence of myocardial infarction (MI) and death. [1][2][3] Drug-eluting stents (DES) have reduced restenosis and target vessel revascularization compared with bare metal stents, but less complete strut coverage and delayed healing may predispose to increased ST with these devices. 4,5 The correlates and consequences of ST after stent implantation have been evaluated in patient populations treated with bare metal stents and early-generation DES, 1,5-10 but there are limited studies from a more contemporary all-comers patient population, including the use of newer generation DES. 11The Assessment of Dual Anti-Platelet Therapy With DrugEluting Stents (ADAPT-DES) study is the largest prospective investigation to date evaluating the correlates and consequences of ST in patients treated with DES in an all-comers population.12 The study included a large proportion of patients treated with new-generation DES, evaluated routine testing of platelet reactivity after aspirin and clopidogrel loading, and assessed the role of intravascular ultrasound (IVUS) guidance Background-Previous studies evaluating correlates of stent thrombosis (ST) have included mostly patients with bare metal stents and early-generation drug-eluting stents (DES) and have not systematically evaluated the role of intravascular ultrasound-guided stenting and high platelet reactivity on clopidogrel. The purpose of this study was to evaluate the frequency and correlates of ST in patients receiving DES, specifically examining the impact of risk factors modifiable by physician and patient behavior. Methods and Results-Assessment of Dual Anti-platelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a multicenter, prospective study in patients undergoing successful coronary intervention with DES in whom routine platelet reactivity testing was performed.

Section: Modifiable Risk Factors For Stmentioning

confidence: 89%

Fixed and Modifiable Correlates of Drug-Eluting Stent Thrombosis From a Large All-Comers Registry

Brodie

Garg

Stuckey

et al. 2015

“…11,13,18,22 Krucoff et al 18 demonstrated the absence of ST with DAPT interruption beyond 6 months after CoCr-EES implantation from a postmarket surveillance study of 5054 real-world patients. Kedhi et al 16,22,23 reported from a pooled analysis of 4 randomized trials that DAPT discontinuation beyond 6 months after CoCr-EES implantation may be safe.…”

Section: Discussionmentioning

confidence: 99%

“…In a large registry study of patients receiving CoCr-EES, discontinuation of DAPT before 30 days was associated with an increased rate of ST 13 ; this study did not, however, examine the rates of ST as a function of DAPT discontinuation in circumscribed risk periods after 30 days. We therefore analyzed the relationship between ST and DAPT use through 2 years in a large, pooled sample of patients from the CoCr-EES Xience V family of clinical studies.…”

Section: Généreux Et Al Stent Thrombosis and Dapt Interruptionmentioning

confidence: 99%

Stent Thrombosis and Dual Antiplatelet Therapy Interruption With Everolimus-Eluting Stents

Généreux

Rutledge

Palmerini

et al. 2015

Self Cite

C urrent guidelines recommend dual antiplatelet therapy (DAPT) for at least 6 months (European Securities Committee)1 and 1 year (American College of Cardiology/ American Heart Association/Society for Cardiac Angiography and Interventions) 2 after drug-eluting stents (DES) to prevent stent thrombosis (ST), based on studies suggesting that firstgeneration DES are associated with increased rates of ST with premature DAPT discontinuation.3-6 Compared with bare-metal stents and first-generation DES, cobalt-chromium everolimus-eluting stent (CoCr-EES) has in several reports been associated with the lowest rates of early, late, and very late ST. [7][8][9][10] As prolonged use of DAPT has been associated with a significant risk of major bleeding, 11,12 knowing whether short-term DAPT might be safe in patients treated with EES is Background-Whether premature dual antiplatelet therapy (DAPT) interruption is safe in patients receiving cobalt chromium everolimus-eluting stents remains controversial. We sought to examine the relationship between DAPT discontinuation and stent thrombosis (ST) after cobalt chromium everolimus-eluting stents. Methods and Results-Outcomes from 11 219 patients were pooled from 3 randomized trials and 4 registries with 2-year follow-up period after cobalt chromium everolimus-eluting stent implantation. . Conclusions-In this large pooled experience, permanent DAPT discontinuation before 30 days after cobalt chromium everolimus-eluting stent implantation was strongly associated with ST, whereas DAPT discontinuation beyond 90 days appeared safe.

“…It is known that the stented length is a strong predictor of events at follow-up, such as stent thrombosis and need for repeat revascularization. 53,54 Additionally, the permanent caging of the artery inhibits the recovery of the physiological properties of the vessel. In CTO PCI, BVS could have obvious advantages compared with metallic stents by fully avoiding the problems arising from having permanent metal caging in the vessel.…”

Section: Bvs In Chronic Total Occlusionsmentioning

confidence: 99%

Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease

Testa

Latib

Montone

et al. 2016

Bioresorbable vascular scaffolds (BVS) represent a promising novel approach for the treatment of coronary artery disease. BVS promise to address some of the well-known limitations of current drug-eluting stents, while providing a transient scaffolding of the vessel to prevent acute vessel closure/recoil. Drug elution by BVS prevents neointimal proliferation in a similar fashion to drug-eluting stents, and complete bioresorption is associated with late vessel lumen enlargement, plaque regression, and restoration of vasomotion. Based on the pathophysiological reasons and on the results derived from clinical studies, BVS are increasingly being used in clinical practice. The aim of this review is to provide an overview of the current evidence supporting the use of BVS in clinical practice. In particular, we will discuss the randomized controlled trials and registries evaluating the clinical outcome of these devices, with a special focus on their application in patients with acute coronary syndrome and in specific lesion subsets (bifurcations, chronic total occlusions, and in-stent restenosis).