Incidence of Stent Thrombosis and Adverse Cardia
Incidence of Stent Thrombosis and Adverse Cardia
Background: The long-term incidence of stent thrombosis (ST) and complications after sirolimus-eluting stents (SES) implantation is still a matter of debate.
Method: We conducted a systematic follow-up on the day of their 5-year SES implantation anniversary, in a series of consecutive real-world patients treated with a SES. The use of SES implantation was not restricted to "on-label" indications, and target lesions included in-stent restenosis, vein graft, left main stem locations, bifurcations, and long lesions. The Academic Research Consortium criteria were used for ST classification.
Results: Three hundred fifty consecutive patients were treated with SES between April and December 2002 in 3 Swiss hospitals. Mean age was 63 ± 6 years, 78% were men, 20% presented with acute coronary syndrome, and 19% were patients with diabetes. Five-year follow-up was obtained in 98% of eligible patients. Stent thrombosis had occurred in 12 patients (3.6%) [definite 6 (1.8%), probable 1 (0.3%) and possible 5 (1.5%)]. Eighty-one percent of the population was free of complications. Major adverse cardiac events occurred in 74 (21%) patients and were as follows: cardiac death 3%, noncardiac death 4%, myocardial infarction 2%, target lesion revascularization 8%, non-target lesion revascularization target vessel revascularization 3%, coronary artery bypass graft 2%. Non-TVR was performed in 8%.
Conclusion: Our data confirm the good long-term outcome of patients treated with SES. The incidence of complications and sub acute thrombosis at 5 years in routine clinical practice reproduces the results of prospective randomized trials.
The use of stents has significantly improved the outcome of percutaneous coronary interventions (PCI). However, despite major advances in angioplasty and stenting, in-stent restenosis and stent thrombosis (ST) have remained major limitations. In 2002, sirolimus-eluting stents (SES) have emerged as a very promising approach in preventing restenosis and have been shown to have a major beneficial impact on both the angiographic and the clinical outcome. However, even more than with bare metal stents (BMSs), ST represents a clinical challenge after SES implantation. Because some have suspected that ST is more frequent after SES placement, obtaining long-term follow-up data is of critical importance. Longer-term follow-up is still very scarce. We report here the complete 5-year follow-up of our first 350 consecutive patients treated with SES just after the introduction on the Swiss market to determine the incidence of major adverse cardiac events (MACE) and ST in routine clinical practice.
Abstract and Introduction
Abstract
Background: The long-term incidence of stent thrombosis (ST) and complications after sirolimus-eluting stents (SES) implantation is still a matter of debate.
Method: We conducted a systematic follow-up on the day of their 5-year SES implantation anniversary, in a series of consecutive real-world patients treated with a SES. The use of SES implantation was not restricted to "on-label" indications, and target lesions included in-stent restenosis, vein graft, left main stem locations, bifurcations, and long lesions. The Academic Research Consortium criteria were used for ST classification.
Results: Three hundred fifty consecutive patients were treated with SES between April and December 2002 in 3 Swiss hospitals. Mean age was 63 ± 6 years, 78% were men, 20% presented with acute coronary syndrome, and 19% were patients with diabetes. Five-year follow-up was obtained in 98% of eligible patients. Stent thrombosis had occurred in 12 patients (3.6%) [definite 6 (1.8%), probable 1 (0.3%) and possible 5 (1.5%)]. Eighty-one percent of the population was free of complications. Major adverse cardiac events occurred in 74 (21%) patients and were as follows: cardiac death 3%, noncardiac death 4%, myocardial infarction 2%, target lesion revascularization 8%, non-target lesion revascularization target vessel revascularization 3%, coronary artery bypass graft 2%. Non-TVR was performed in 8%.
Conclusion: Our data confirm the good long-term outcome of patients treated with SES. The incidence of complications and sub acute thrombosis at 5 years in routine clinical practice reproduces the results of prospective randomized trials.
Introduction
The use of stents has significantly improved the outcome of percutaneous coronary interventions (PCI). However, despite major advances in angioplasty and stenting, in-stent restenosis and stent thrombosis (ST) have remained major limitations. In 2002, sirolimus-eluting stents (SES) have emerged as a very promising approach in preventing restenosis and have been shown to have a major beneficial impact on both the angiographic and the clinical outcome. However, even more than with bare metal stents (BMSs), ST represents a clinical challenge after SES implantation. Because some have suspected that ST is more frequent after SES placement, obtaining long-term follow-up data is of critical importance. Longer-term follow-up is still very scarce. We report here the complete 5-year follow-up of our first 350 consecutive patients treated with SES just after the introduction on the Swiss market to determine the incidence of major adverse cardiac events (MACE) and ST in routine clinical practice.
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