Correlates of late and very late thrombosis of drug eluting stents

Mishkel, Gregory; Moore, Anna L.; Markwell, Steve; Shelton, Marc E.

doi:10.1016/j.ahj.2008.02.012

Cited by 27 publications

(13 citation statements)

References 41 publications

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“…However, this was only seen in the elderly patients (80 years and older) which may not necessary relate to a lower rate of ST but may rather be explained by a lower reangiography rate in this subpopulation. Similar to the study by Mishkel et al, 18 we found a higher risk of ST in smokers than in nonsmokers and exsmokers. This relationship seems logical and is supported by the relationship between smoking and elevated levels of coagulation markers.…”

Section: Discussionsupporting

confidence: 81%

Stent Thrombosis in Sweden

Lagerqvist

Carlsson

Fröbert

et al. 2009

Circ: Cardiovascular Interventions

125

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Section: Discussionsupporting

confidence: 81%

Stent Thrombosis in Sweden

Lagerqvist

Carlsson

Fröbert

et al. 2009

Circ: Cardiovascular Interventions

125

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“…[2][3][4][5] DES implantation (an SES or PES) for de novo coronary artery lesions in patients with severe RI reduced 1-year clinical cardiac events compared with BMS, mainly by reducing TVR, without an effect on mortality. 5,57,63 Mishkel et al 58 demonstrated that the 18-month survival free from TVR after implantation of SES vs PES was similar, regardless of the severity of RI.…”

Section: Comparison Of Des Use In Dialysis and Nondialysis Patientsmentioning

confidence: 99%

“…Six studies 24,45,57,58,62,63 compared DES use in nondialysis vs dialysis patients with RI; 5 of these studies used both DES and BMS (Table 3). Four studies were conducted among nondialysis patients with RI.…”

Section: Comparison Of Des Use In Dialysis and Nondialysis Patientsmentioning

confidence: 99%

“…13 In the current review, we tallied the outcomes of 12,189 patients with various degrees of chronic RI who underwent DES implantation in 16 studies. [2][3][4][5]24,38,42,45,53,[57][58][59][60][61][62][63] Ten studies compared DES and BMS use [3][4][5]38,42,53,57,60,61,63 ; the DES subtype was specified in 12 studies (SES ). One study reported on all 3 types of stents in chronic RI.…”

Section: Impact Of Chronic Ri On Outcomes After Des Usementioning

confidence: 99%

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Use of Drug-Eluting Stents in Patients With Coronary Artery Disease and Renal Insufficiency

El‐Menyar

Suwaidi

Holmes

2010

Mayo Clinic Proceedings

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Renal insufficiency (RI) has been shown to be associated with increased major adverse cardiovascular events after percutaneous coronary intervention. We reviewed the impact of RI on the pathogenesis of coronary artery disease and outcomes after percutaneous coronary intervention in the form of drug-eluting stent (DES) implantation in these high-risk patients. We searched the English-language literature indexed in MEDLINE, Scopus, and EBS-CO Host research databases from 1990 through January 2009, using as search terms coronary revascularization, drug-eluting stent, and renal insufficiency. Studies that assessed DES implantation in patients with various degrees of RI were selected for review. Most of the available data were extracted from observational studies, and data from randomized trials formed the basis of a post hoc analysis. The outcomes after coronary revascularization were less favorable in patients with RI than in those with normal renal function. In patients with RI, DES implantation yielded better outcomes than did use of bare-metal stents. Randomized trials are needed to define optimal treatment of these high-risk patients with coronary artery disease. © 2010 Mayo Foundation for Medical Education and ResearchR enal insufficiency (RI), defined as creatinine clearance lower than or equal to 60 mL/min, is prevalent in patients with coronary artery disease (CAD). [1][2][3][4][5] In patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI), even mild RI is an independent predictor of worse outcomes.1 Renal insufficiency is a potent risk factor for CAD and qualifies as a coronary risk equivalent. Chronic RI not only increases cardiovascular event risk but also is associated with worse outcomes if an event occurs. 6 Diagnostic coronary angiography and PCI are used less frequently in patients with reduced renal function; risk of complications from these procedures is increased in the presence of RI. 7,8 This increased risk has been shown to occur at even moderate levels of RI, despite the use of advanced stent technology and optimal adjunctive medical therapy. Best et al 10 reported an RI prevalence of 49.1% in patients undergoing elective PCI. In that study, RI had a negative impact similar to that of diabetes mellitus (DM) on cardiovascular outcomes.10 One year after PCI, chronic RI was associated with a doubling of mortality in patients with mild RI, a 5-fold increase in patients with moderate RI, and a 12-fold increase in patients with severe RI. 10 In primary PCI for myocardial infarction (MI), a notable incremental reduction in survival was evident for each decline of 10 mL/min in creatinine clearance.11 Unfortunately, most randomized trials of patients undergoing PCI have excluded patients with severe RI. 12,13 This narrative review aims to identify the impact of a drug-eluting stent (DES) in the performance of PCI in patients with RI. METHODSWe evaluated the impact of RI on the pathogenesis of CAD and outcomes after PCI (in the form of DES implantation) in these high...

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“…W rejestrze Bern/Rotterdam, obejmującym 8146 chorych ze złożoną anatomią zwężeń, odnotowano 0,6% pewnych (udokumentowanych angiograficznie) przypadków późnej i bardzo późnej zakrzepicy w DES na rok [179]. Podobne wyniki, z częstością ST 1,8% na 3 lata, uzyskali autorzy rejestru obejmującego 5342 chorych [180]. Wadą wspomnianych obserwacji jest brak grupy kontrolnej, którą w przypadku zastosowania DES poza wskazaniami rejestracyjnymi powinni stanowić chorzy po CABG [181,182].…”

Section: Zakrzepica W Stencieunclassified

Association on cardiovascular interventions of PCS Current status of drug-eluting stents and drug-eluting balloons in patients with stable coronary artery disease: An expert consensus document of the Association for Percutaneous Cardiovascular Interventions and Polish Cardiac Society

Witkowski¹,

Opolski²,

Dudek³

et al. 2011

pwki

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S t r e s z c z e n i ePomimo istotnego zmniejszania częstości restenozy i ponownych zabiegów rewaskularyzacyjnych przez stenty uwalniające leki antyproliferacyjne (ang. drug eluting stents -DES), istnieją sprzeczne dane na temat podwyższonego ryzyka występowania późnej zakrzepicy w DES w porównaniu ze stentami metalowymi (ang. bare metal stent -BMS). Z pewnością wynika to z różnej skuteczności i bezpieczeństwa poszczególnych rodzajów DES, których liczba systematycznie się zwiększa. Ponadto w ostatnim okresie obserwujemy stopniowe zwiększenie dostępności DES, które nie osiągnęły pierwszorzędowych punktów końcowych w badaniach z randomizacją. Z tego powodu w przypadku DES nie można mówić o efekcie klasy. Niniejszy dokument stanowi analizę 110 badań klinicznych z randomizacją poświęconych DES, obejmujących 72 305 chorych. Celem niniejszego stanowiska jest usystematyzowanie wiedzy o DES oraz ocena wskazań do ich implantacji w różnych sytuacjach klinicznych.Słowa kluczowe: stenty uwalniające leki antyproliferacyjne, balony uwalniające leki antyproliferacyjne, badania kliniczne z randomizacją A b s t r a c tDespite a dramatic reduction in restenosis and target vessel revascularization rates by drug-eluting stents (DES), conflicting concerns have been raised over the risk of late DES thrombosis when compared to bare-metal stents. Certainly, the heterogeneity of DES results from the introduction of a great variety of new DES types with diverse efficacy and safety parameters. Furthermore, there is a steady increase in DES availability without parallel and robust data from randomized clinical trials. Thus, the postulated class effect of DES should be regarded as non-obligatory. This article is based on 110 randomized DES trials performed on 72 305 patients. Current status of DES and guidelines for DES implantation in various clinical scenarios are discussed.

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Correlates of late and very late thrombosis of drug eluting stents

Cited by 27 publications

References 41 publications

Stent Thrombosis in Sweden

Stent Thrombosis in Sweden

Use of Drug-Eluting Stents in Patients With Coronary Artery Disease and Renal Insufficiency

Association on cardiovascular interventions of PCS Current status of drug-eluting stents and drug-eluting balloons in patients with stable coronary artery disease: An expert consensus document of the Association for Percutaneous Cardiovascular Interventions and Polish Cardiac Society

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