Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and bare metal stent implantation

Gregg W. Stone, Stephen G. Ellis, Antonio Colombo, Keith D. Dawkins, Eberhard Grube, Donald E. Cutlip, Mark Friedman, Donald S. Baim, Joerg Koglin

Research output: Contribution to journalArticle

157 Citations (Scopus)

Abstract

BACKGROUND - Drug-eluting stents compared with bare metal stents (BMS) may increase late stent thrombosis (ST), although an accompanying increase in the rates of death and myocardial infarction (MI) has not been observed. We hypothesized that the prevention of restenosis-related adverse events by drug-eluting stents might offset some or all of the excess risk from ST. METHODS AND RESULTS - We analyzed a pooled patient-level database from 4 prospective, double-blind trials in which 3445 patients were randomized to paclitaxel-eluting stents or BMS. The occurrence of death or MI within 7 days of ST or target lesion revascularization was assessed. With a median follow-up of 3.2 years, ST occurred in 34 patients (1.0%), 31 (91.1%) of whom sustained death or MI within 7 days. Target lesion revascularization was performed in 425 patients (12.3%), 15 (3.5%) of whom died or had MI within 7 days. ST occurred in 14 BMS and 20 paclitaxel-eluting stent patients, resulting in 12 and 19 deaths or MIs within 7 days, respectively. Target lesion revascularization was performed in 290 BMS and 135 paclitaxel-eluting stent patients, resulting in 11 and 4 deaths or MI events within 7 days, respectively. In total, 23 patients in both the BMS and paclitaxel-eluting stents groups died or had an MI event within 7 days of either ST or target lesion revascularization. CONCLUSIONS - ST, although infrequent, results in a high incident rate of death and MI, whereas the more frequent occurrence of target lesion revascularization is associated with a finite but lower rate of death and MI. The marked reduction in restenosis with drug-eluting stents compared with BMS may counterbalance the potential excess risk from late ST with drug-eluting stents.

Original languageEnglish
Pages (from-to)2842-2847
Number of pages6
JournalCirculation
Volume115
Issue number22
DOIs
Publication statusPublished - Jun 2007

Fingerprint

Paclitaxel
Stents
Thrombosis
Metals
Myocardial Infarction
Drug-Eluting Stents
Mortality

Keywords

  • Mortality
  • Myocardial infarction
  • Restenosis
  • Stent
  • Thrombosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and bare metal stent implantation. / Stone, Gregg W.; Ellis, Stephen G.; Colombo, Antonio; Dawkins, Keith D.; Grube, Eberhard; Cutlip, Donald E.; Friedman, Mark; Baim, Donald S.; Koglin, Joerg.

In: Circulation, Vol. 115, No. 22, 06.2007, p. 2842-2847.

Research output: Contribution to journalArticle

Stone, GW, Ellis, SG, Colombo, A, Dawkins, KD, Grube, E, Cutlip, DE, Friedman, M, Baim, DS & Koglin, J 2007, 'Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and bare metal stent implantation', Circulation, vol. 115, no. 22, pp. 2842-2847. https://doi.org/10.1161/CIRCULATIONAHA.106.687186
Stone, Gregg W. ; Ellis, Stephen G. ; Colombo, Antonio ; Dawkins, Keith D. ; Grube, Eberhard ; Cutlip, Donald E. ; Friedman, Mark ; Baim, Donald S. ; Koglin, Joerg. / Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and bare metal stent implantation. In: Circulation. 2007 ; Vol. 115, No. 22. pp. 2842-2847.
@article{7ad4ce16bd9e4b9192ed8c45e419d888,
title = "Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and bare metal stent implantation",
abstract = "BACKGROUND - Drug-eluting stents compared with bare metal stents (BMS) may increase late stent thrombosis (ST), although an accompanying increase in the rates of death and myocardial infarction (MI) has not been observed. We hypothesized that the prevention of restenosis-related adverse events by drug-eluting stents might offset some or all of the excess risk from ST. METHODS AND RESULTS - We analyzed a pooled patient-level database from 4 prospective, double-blind trials in which 3445 patients were randomized to paclitaxel-eluting stents or BMS. The occurrence of death or MI within 7 days of ST or target lesion revascularization was assessed. With a median follow-up of 3.2 years, ST occurred in 34 patients (1.0{\%}), 31 (91.1{\%}) of whom sustained death or MI within 7 days. Target lesion revascularization was performed in 425 patients (12.3{\%}), 15 (3.5{\%}) of whom died or had MI within 7 days. ST occurred in 14 BMS and 20 paclitaxel-eluting stent patients, resulting in 12 and 19 deaths or MIs within 7 days, respectively. Target lesion revascularization was performed in 290 BMS and 135 paclitaxel-eluting stent patients, resulting in 11 and 4 deaths or MI events within 7 days, respectively. In total, 23 patients in both the BMS and paclitaxel-eluting stents groups died or had an MI event within 7 days of either ST or target lesion revascularization. CONCLUSIONS - ST, although infrequent, results in a high incident rate of death and MI, whereas the more frequent occurrence of target lesion revascularization is associated with a finite but lower rate of death and MI. The marked reduction in restenosis with drug-eluting stents compared with BMS may counterbalance the potential excess risk from late ST with drug-eluting stents.",
keywords = "Mortality, Myocardial infarction, Restenosis, Stent, Thrombosis",
author = "Stone, {Gregg W.} and Ellis, {Stephen G.} and Antonio Colombo and Dawkins, {Keith D.} and Eberhard Grube and Cutlip, {Donald E.} and Mark Friedman and Baim, {Donald S.} and Joerg Koglin",
year = "2007",
month = "6",
doi = "10.1161/CIRCULATIONAHA.106.687186",
language = "English",
volume = "115",
pages = "2842--2847",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "22",

}

TY - JOUR

T1 - Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and bare metal stent implantation

AU - Stone, Gregg W.

AU - Ellis, Stephen G.

AU - Colombo, Antonio

AU - Dawkins, Keith D.

AU - Grube, Eberhard

AU - Cutlip, Donald E.

AU - Friedman, Mark

AU - Baim, Donald S.

AU - Koglin, Joerg

PY - 2007/6

Y1 - 2007/6

N2 - BACKGROUND - Drug-eluting stents compared with bare metal stents (BMS) may increase late stent thrombosis (ST), although an accompanying increase in the rates of death and myocardial infarction (MI) has not been observed. We hypothesized that the prevention of restenosis-related adverse events by drug-eluting stents might offset some or all of the excess risk from ST. METHODS AND RESULTS - We analyzed a pooled patient-level database from 4 prospective, double-blind trials in which 3445 patients were randomized to paclitaxel-eluting stents or BMS. The occurrence of death or MI within 7 days of ST or target lesion revascularization was assessed. With a median follow-up of 3.2 years, ST occurred in 34 patients (1.0%), 31 (91.1%) of whom sustained death or MI within 7 days. Target lesion revascularization was performed in 425 patients (12.3%), 15 (3.5%) of whom died or had MI within 7 days. ST occurred in 14 BMS and 20 paclitaxel-eluting stent patients, resulting in 12 and 19 deaths or MIs within 7 days, respectively. Target lesion revascularization was performed in 290 BMS and 135 paclitaxel-eluting stent patients, resulting in 11 and 4 deaths or MI events within 7 days, respectively. In total, 23 patients in both the BMS and paclitaxel-eluting stents groups died or had an MI event within 7 days of either ST or target lesion revascularization. CONCLUSIONS - ST, although infrequent, results in a high incident rate of death and MI, whereas the more frequent occurrence of target lesion revascularization is associated with a finite but lower rate of death and MI. The marked reduction in restenosis with drug-eluting stents compared with BMS may counterbalance the potential excess risk from late ST with drug-eluting stents.

AB - BACKGROUND - Drug-eluting stents compared with bare metal stents (BMS) may increase late stent thrombosis (ST), although an accompanying increase in the rates of death and myocardial infarction (MI) has not been observed. We hypothesized that the prevention of restenosis-related adverse events by drug-eluting stents might offset some or all of the excess risk from ST. METHODS AND RESULTS - We analyzed a pooled patient-level database from 4 prospective, double-blind trials in which 3445 patients were randomized to paclitaxel-eluting stents or BMS. The occurrence of death or MI within 7 days of ST or target lesion revascularization was assessed. With a median follow-up of 3.2 years, ST occurred in 34 patients (1.0%), 31 (91.1%) of whom sustained death or MI within 7 days. Target lesion revascularization was performed in 425 patients (12.3%), 15 (3.5%) of whom died or had MI within 7 days. ST occurred in 14 BMS and 20 paclitaxel-eluting stent patients, resulting in 12 and 19 deaths or MIs within 7 days, respectively. Target lesion revascularization was performed in 290 BMS and 135 paclitaxel-eluting stent patients, resulting in 11 and 4 deaths or MI events within 7 days, respectively. In total, 23 patients in both the BMS and paclitaxel-eluting stents groups died or had an MI event within 7 days of either ST or target lesion revascularization. CONCLUSIONS - ST, although infrequent, results in a high incident rate of death and MI, whereas the more frequent occurrence of target lesion revascularization is associated with a finite but lower rate of death and MI. The marked reduction in restenosis with drug-eluting stents compared with BMS may counterbalance the potential excess risk from late ST with drug-eluting stents.

KW - Mortality

KW - Myocardial infarction

KW - Restenosis

KW - Stent

KW - Thrombosis

UR - http://www.scopus.com/inward/record.url?scp=34249877707&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34249877707&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.106.687186

DO - 10.1161/CIRCULATIONAHA.106.687186

M3 - Article

C2 - 17515458

AN - SCOPUS:34249877707

VL - 115

SP - 2842

EP - 2847

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 22

ER -