Very Late Coronary Stent Thrombosis of a Newer-Generation Everolimus-Eluting Stent Compared With Early-Generation Drug-Eluting Stents

Abstract

Background-Early-generation drug-eluting stents releasing sirolimus (SES) or paclitaxel (PES) are associated with increased risk of very late stent thrombosis occurring Ͼ1 year after stent implantation. It is unknown whether the risk of very late stent thrombosis persists with newer-generation everolimus-eluting stents (EES). Methods and Results-We assessed the risk of stent thrombosis in a cohort of 12 339 patients with unrestricted use of drug-eluting stents (3819 SES, 4308 PES, 4212 EES). Results are incidence rates per 100 person-years after inverse probability of treatment weighting to adjust for group differences. During follow-up of up to 4 years, the overall incidence rate of definite stent thrombosis was lower with EES (1.4 per 100 person-years) compared with SES (2.9; hazard ratio, 0.41; 95% confidence interval, 0.27-0.62; PϽ0.0001) and PES (4.4; hazard ratio, 0.33; 95% confidence interval, 0.23-0.48; PϽ0.0001). The incidence rate per 100 person-years of early (0 -30 days), late (31 days-1 year), and very late stent thrombosis amounted to 0.6, 0.1, and 0.6 among EES-treated patients; 1.0, 0.3, and 1.6 among SES-treated patients; and 1.3, 0.7, and 2.4 among PES-treated patients. Differences in favor of EES were most pronounced beyond 1 year, with a hazard ratio of 0.

Safety and Efficacy of Resolute Zotarolimus-Eluting Stents Compared With Everolimus-Eluting Stents

“…20 In recent years, new-generation DES replaced early-generation DES because of improved stent design, similar or superior antirestenotic efficacy, and consistently lower rates of late ST. 21,22 Both zotarolimus and everolimus are sirolimus analogues, in which the hydroxyl group at position 40 of the sirolimus has been replaced by a lipophilic tetrazole and hydroxyethyl group, respectively. Antiproliferative agents are released from biocompatible durable polymers in both devices: the BioLink polymer in R-ZES, which consists of 3 polymers (a hydrophobic C10 polymer, a hydrophilic C19 polymer, and water-soluble polyvinyl pyrrolidinone) and a 2-layer polymer system in EES, with an acrylate primer and a fluorinated copolymer.…”

Long‐term (8 year) outcomes and predictors of major adverse cardiac events after full metal jacket drug‐eluting stent implantation

“…The superiority of new DES over previous DES can be seen in the reduced risk of stent thrombosis [13,14]. Therefore, the FMJ approach with new DES seems to have better long-term outcomes compared with previous DES.…”

Randomized comparison of biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents for percutaneous coronary revascularization: Rationale and design of the BIOSCIENCE trial

“…New generation DES with thin strut stent platforms, biocompatible polymers and lower dosages of limus-analogues largely eliminated the risk of very late stent thrombosis while maintaining the antirestenotic efficacy of early generation DES (3,4).…”