Outcomes of Stent Thrombosis and Restenosis During Extended Follow-Up of Patients Treated With Bare-Metal Coronary Stents
Concern regarding risk of late thrombosis after "off-label" treatment with drug-eluting stents has prompted increased use of bare-metal stents (BMS) in current practice. The sequelae of late BMS failures, however, have been poorly characterized. We performed a retrospective study of 4503 c...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2007-11, Vol.116 (21), p.2391-2398 |
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| container_title | Circulation (New York, N.Y.) |
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| creator | DOYLE, Brendan RIHAL, Charanjit S O'SULLIVAN, Crochan J LENNON, Ryan J WISTE, Heather J BELL, Malcolm BRESNAHAN, John HOLMES, David R |
| description | Concern regarding risk of late thrombosis after "off-label" treatment with drug-eluting stents has prompted increased use of bare-metal stents (BMS) in current practice. The sequelae of late BMS failures, however, have been poorly characterized.
We performed a retrospective study of 4503 consecutive patients treated with at least 1 BMS and dual antiplatelet therapy between 1994 and 2000. The cumulative incidence of stent thrombosis was 0.5% at 30 days (95% CI, 0.3% to 0.7%), 0.8% at 1 year (95% CI, 0.6% to 1.1%), and 2.0% at 10 years (95% CI, 1.5% to 2.5%). Risk of late (30 days to 1 year) and very late (>1 year) BMS thrombosis was increased among patients considered off label for drug-eluting stent use (P=0.024). When saphenous vein graft interventions were excluded, however, risk after off-label use was not significantly increased (P=0.23). Other correlates included vein graft intervention, prior myocardial infarction (MI), peripheral vascular disease, and ulcerated lesion (P |
| doi_str_mv | 10.1161/CIRCULATIONAHA.107.707331 |
| format | Article |
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We performed a retrospective study of 4503 consecutive patients treated with at least 1 BMS and dual antiplatelet therapy between 1994 and 2000. The cumulative incidence of stent thrombosis was 0.5% at 30 days (95% CI, 0.3% to 0.7%), 0.8% at 1 year (95% CI, 0.6% to 1.1%), and 2.0% at 10 years (95% CI, 1.5% to 2.5%). Risk of late (30 days to 1 year) and very late (>1 year) BMS thrombosis was increased among patients considered off label for drug-eluting stent use (P=0.024). When saphenous vein graft interventions were excluded, however, risk after off-label use was not significantly increased (P=0.23). Other correlates included vein graft intervention, prior myocardial infarction (MI), peripheral vascular disease, and ulcerated lesion (P<0.001). Mortality was markedly increased after late and very late BMS thrombosis, particularly during the first 30 days (hazard ratios, 22 [95% CI, 3.1 to 159] and 40 [95% CI, 15 to 107], respectively). The 10-year incidence of clinical restenosis was 18.1% (95% CI, 16.5% to 19.7%), presenting with MI in 2.1% (95% CI, 1.6% to 2.6%). Restenosis presenting with MI was associated with increased mortality compared with no restenosis (hazard ratio, 2.37; P<0.001) and with restenosis with a non-MI presentation (hazard ratio, 2.42; P<0.001).
The incidence of BMS thrombosis and of MI caused by restenosis during extended follow-up is significant. Both complications are associated with mortality.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.107.707331</identifier><identifier>PMID: 17984377</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Angioplasty, Balloon, Coronary - adverse effects ; Angioplasty, Balloon, Coronary - trends ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Cohort Studies ; Coronary heart disease ; Coronary Restenosis - epidemiology ; Coronary Restenosis - etiology ; Coronary Restenosis - mortality ; Coronary Thrombosis - epidemiology ; Coronary Thrombosis - etiology ; Coronary Thrombosis - mortality ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Follow-Up Studies ; Heart ; Humans ; Male ; Medical sciences ; Metals - adverse effects ; Middle Aged ; Retrospective Studies ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Stents - adverse effects ; Stents - trends ; Time Factors ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 2007-11, Vol.116 (21), p.2391-2398</ispartof><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-946b18060b1bad87bf0aa9c237462eeb2e03f35b9626ad590527a900fb15c8d13</citedby><cites>FETCH-LOGICAL-c439t-946b18060b1bad87bf0aa9c237462eeb2e03f35b9626ad590527a900fb15c8d13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19869273$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17984377$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DOYLE, Brendan</creatorcontrib><creatorcontrib>RIHAL, Charanjit S</creatorcontrib><creatorcontrib>O'SULLIVAN, Crochan J</creatorcontrib><creatorcontrib>LENNON, Ryan J</creatorcontrib><creatorcontrib>WISTE, Heather J</creatorcontrib><creatorcontrib>BELL, Malcolm</creatorcontrib><creatorcontrib>BRESNAHAN, John</creatorcontrib><creatorcontrib>HOLMES, David R</creatorcontrib><title>Outcomes of Stent Thrombosis and Restenosis During Extended Follow-Up of Patients Treated With Bare-Metal Coronary Stents</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Concern regarding risk of late thrombosis after "off-label" treatment with drug-eluting stents has prompted increased use of bare-metal stents (BMS) in current practice. The sequelae of late BMS failures, however, have been poorly characterized.
We performed a retrospective study of 4503 consecutive patients treated with at least 1 BMS and dual antiplatelet therapy between 1994 and 2000. The cumulative incidence of stent thrombosis was 0.5% at 30 days (95% CI, 0.3% to 0.7%), 0.8% at 1 year (95% CI, 0.6% to 1.1%), and 2.0% at 10 years (95% CI, 1.5% to 2.5%). Risk of late (30 days to 1 year) and very late (>1 year) BMS thrombosis was increased among patients considered off label for drug-eluting stent use (P=0.024). When saphenous vein graft interventions were excluded, however, risk after off-label use was not significantly increased (P=0.23). Other correlates included vein graft intervention, prior myocardial infarction (MI), peripheral vascular disease, and ulcerated lesion (P<0.001). Mortality was markedly increased after late and very late BMS thrombosis, particularly during the first 30 days (hazard ratios, 22 [95% CI, 3.1 to 159] and 40 [95% CI, 15 to 107], respectively). The 10-year incidence of clinical restenosis was 18.1% (95% CI, 16.5% to 19.7%), presenting with MI in 2.1% (95% CI, 1.6% to 2.6%). Restenosis presenting with MI was associated with increased mortality compared with no restenosis (hazard ratio, 2.37; P<0.001) and with restenosis with a non-MI presentation (hazard ratio, 2.42; P<0.001).
The incidence of BMS thrombosis and of MI caused by restenosis during extended follow-up is significant. Both complications are associated with mortality.</description><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary - adverse effects</subject><subject>Angioplasty, Balloon, Coronary - trends</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Cohort Studies</subject><subject>Coronary heart disease</subject><subject>Coronary Restenosis - epidemiology</subject><subject>Coronary Restenosis - etiology</subject><subject>Coronary Restenosis - mortality</subject><subject>Coronary Thrombosis - epidemiology</subject><subject>Coronary Thrombosis - etiology</subject><subject>Coronary Thrombosis - mortality</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Metals - adverse effects</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Stents - adverse effects</subject><subject>Stents - trends</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkF9PwjAUxRujEUS_gqkPPg77Z1vXxzlBSFAMjvi4tFsnM9tK2hHl21scCfHp5p57fvfeHADuMBpjHOKHZL5K1os4nS9f41k8xoiNGWKU4jMwxAHxPT-g_BwMEULcY5SQAbiy9su1IWXBJRhgxiOfMjYE--Wuy3WjLNQlfO9U28F0Y3Qjta0sFG0BV8o6-a992pmq_YSTHycUqoBTXdf621tvD_Cb6CqHW5gaJTo3_ai6DXwURnkvqhM1TLTRrTD7_oy9BhelqK26OdYRWE8naTLzFsvneRIvvNynvPO4H0ocoRBJLEURMVkiIXhOKPNDopQkCtGSBpKHJBRFwFFAmOAIlRIHeVRgOgK835sbba1RZbY1VeP-yDDKDnFm_-N0Msv6OB1727PbnWxUcSKP-TnD_dEgbC7q0og2r-zJx6OQE7fqFzSSgNQ</recordid><startdate>20071120</startdate><enddate>20071120</enddate><creator>DOYLE, Brendan</creator><creator>RIHAL, Charanjit S</creator><creator>O'SULLIVAN, Crochan J</creator><creator>LENNON, Ryan J</creator><creator>WISTE, Heather J</creator><creator>BELL, Malcolm</creator><creator>BRESNAHAN, John</creator><creator>HOLMES, David R</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20071120</creationdate><title>Outcomes of Stent Thrombosis and Restenosis During Extended Follow-Up of Patients Treated With Bare-Metal Coronary Stents</title><author>DOYLE, Brendan ; RIHAL, Charanjit S ; O'SULLIVAN, Crochan J ; LENNON, Ryan J ; WISTE, Heather J ; BELL, Malcolm ; BRESNAHAN, John ; HOLMES, David R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-946b18060b1bad87bf0aa9c237462eeb2e03f35b9626ad590527a900fb15c8d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary - adverse effects</topic><topic>Angioplasty, Balloon, Coronary - trends</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Cohort Studies</topic><topic>Coronary heart disease</topic><topic>Coronary Restenosis - epidemiology</topic><topic>Coronary Restenosis - etiology</topic><topic>Coronary Restenosis - mortality</topic><topic>Coronary Thrombosis - epidemiology</topic><topic>Coronary Thrombosis - etiology</topic><topic>Coronary Thrombosis - mortality</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Metals - adverse effects</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Stents - adverse effects</topic><topic>Stents - trends</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DOYLE, Brendan</creatorcontrib><creatorcontrib>RIHAL, Charanjit S</creatorcontrib><creatorcontrib>O'SULLIVAN, Crochan J</creatorcontrib><creatorcontrib>LENNON, Ryan J</creatorcontrib><creatorcontrib>WISTE, Heather J</creatorcontrib><creatorcontrib>BELL, Malcolm</creatorcontrib><creatorcontrib>BRESNAHAN, John</creatorcontrib><creatorcontrib>HOLMES, David R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DOYLE, Brendan</au><au>RIHAL, Charanjit S</au><au>O'SULLIVAN, Crochan J</au><au>LENNON, Ryan J</au><au>WISTE, Heather J</au><au>BELL, Malcolm</au><au>BRESNAHAN, John</au><au>HOLMES, David R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Stent Thrombosis and Restenosis During Extended Follow-Up of Patients Treated With Bare-Metal Coronary Stents</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2007-11-20</date><risdate>2007</risdate><volume>116</volume><issue>21</issue><spage>2391</spage><epage>2398</epage><pages>2391-2398</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Concern regarding risk of late thrombosis after "off-label" treatment with drug-eluting stents has prompted increased use of bare-metal stents (BMS) in current practice. The sequelae of late BMS failures, however, have been poorly characterized.
We performed a retrospective study of 4503 consecutive patients treated with at least 1 BMS and dual antiplatelet therapy between 1994 and 2000. The cumulative incidence of stent thrombosis was 0.5% at 30 days (95% CI, 0.3% to 0.7%), 0.8% at 1 year (95% CI, 0.6% to 1.1%), and 2.0% at 10 years (95% CI, 1.5% to 2.5%). Risk of late (30 days to 1 year) and very late (>1 year) BMS thrombosis was increased among patients considered off label for drug-eluting stent use (P=0.024). When saphenous vein graft interventions were excluded, however, risk after off-label use was not significantly increased (P=0.23). Other correlates included vein graft intervention, prior myocardial infarction (MI), peripheral vascular disease, and ulcerated lesion (P<0.001). Mortality was markedly increased after late and very late BMS thrombosis, particularly during the first 30 days (hazard ratios, 22 [95% CI, 3.1 to 159] and 40 [95% CI, 15 to 107], respectively). The 10-year incidence of clinical restenosis was 18.1% (95% CI, 16.5% to 19.7%), presenting with MI in 2.1% (95% CI, 1.6% to 2.6%). Restenosis presenting with MI was associated with increased mortality compared with no restenosis (hazard ratio, 2.37; P<0.001) and with restenosis with a non-MI presentation (hazard ratio, 2.42; P<0.001).
The incidence of BMS thrombosis and of MI caused by restenosis during extended follow-up is significant. Both complications are associated with mortality.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>17984377</pmid><doi>10.1161/CIRCULATIONAHA.107.707331</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0009-7322 |
| ispartof | Circulation (New York, N.Y.), 2007-11, Vol.116 (21), p.2391-2398 |
| issn | 0009-7322 1524-4539 |
| language | eng |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals; Journals@Ovid Complete |
| subjects | Aged Angioplasty, Balloon, Coronary - adverse effects Angioplasty, Balloon, Coronary - trends Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cohort Studies Coronary heart disease Coronary Restenosis - epidemiology Coronary Restenosis - etiology Coronary Restenosis - mortality Coronary Thrombosis - epidemiology Coronary Thrombosis - etiology Coronary Thrombosis - mortality Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Follow-Up Studies Heart Humans Male Medical sciences Metals - adverse effects Middle Aged Retrospective Studies Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Stents - adverse effects Stents - trends Time Factors Treatment Outcome |
| title | Outcomes of Stent Thrombosis and Restenosis During Extended Follow-Up of Patients Treated With Bare-Metal Coronary Stents |
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