Stent Thrombosis in New-Generation Drug-Eluting Stents in Patients With STEMI Undergoing Primary PCI: A Report From SCAAR

Jul 23, 2014
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Authors:
Sarno G, Lagerqvist B, Nilsson J, et al.
Citation:
J Am Coll Cardiol 2014;64:16-24.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the incidence of stent thrombosis (ST) rate up to 3 years in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (n-DES) compared with bare-metal stents (BMS) and old-generation drug-eluting stents (o-DES)?

Methods:

From January 2007 to January 2013, 34,147 patients with STEMI were treated by PCI with n-DES (n = 4,811), o-DES (n = 4,271), or BMS (n = 25,065). The risks of early/late (up to 1 year) and very late definite ST (after 1 year) were estimated. The cumulative adjusted hazard risk of ST up to 3 years was calculated using the Cox proportional hazard method.

Results:

Cox regression landmark analysis showed a significantly lower risk of early/late ST in patients treated with n-DES (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.43-0.99; p = 0.04) and o-DES (HR, 0.60; 95% CI, 0.41-0.89; p = 0.01) compared with the BMS group. The risk of very late ST was similar between the n-DES and BMS groups (HR, 1.52; 95% CI, 0.78-2.98; p = 0.21), whereas a higher risk of very late ST was observed with o-DES compared with BMS (HR, 2.88; 95% CI, 1.70-4.89; p < 0.01).

Conclusions:

The authors concluded that patients treated with n-DES have a lower risk of early/late ST than patients treated with BMS.

Perspective:

This study reports a significantly lower risk of ST during the first year after PCI with both n-DES and o-DES compared with BMS, but a higher risk of very late ST up to 3 years in the o-DES group compared with the BMS group; and a similar risk of very late ST in the n-DES and BMS groups. Although BMS have been proven to be safe in STEMI patients and the improvements of the new stent platforms have reduced restenosis rates, DES are superior in terms of a decrease in restenosis occurrence. This study suggests that n-DES are associated with a low risk of ST even on long-term follow-up and may be the preferred stent type in STEMI patients compared to BMS and o-DES.


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