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Published on: May 14, 2013

Thrombosis and drug-eluting stents: an objective appraisal

David R Holmes1, Dean J Kereiakes, Warren K Laskey

  • 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55955, USA. holmes.david@mayo.edu

Journal of the American College of Cardiology
|July 10, 2007
PubMed

Insights

Stent thrombosis (ST) is a rare but serious complication of coronary stents. Current data show no overall difference in ST frequency between drug-eluting stents (DES) and bare-metal stents (BMS) over four years.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Stent thrombosis (ST) is a significant concern following percutaneous coronary intervention (PCI), associated with high morbidity and mortality.
  • Controversies exist regarding the comparative frequency, timing, and risk factors of ST between drug-eluting stents (DES) and bare-metal stents (BMS).
  • Real-world registry data and randomized controlled trials (RCTs) provide varying perspectives on ST incidence and outcomes.

Purpose of the Study:

  • To synthesize current evidence on stent thrombosis (ST) comparing drug-eluting stents (DES) and bare-metal stents (BMS).
  • To clarify the frequency, timing, clinical consequences, and risk factors associated with ST.
  • To evaluate current and emerging strategies for preventing ST.

Main Methods:

  • Analysis of data from randomized controlled trials (RCTs) comparing DES and BMS in selected patient subsets.
  • Review of registry experiences in larger, more diverse patient populations to provide a real-world perspective.
  • Evaluation of accrued information on clinical outcomes, risk factors, and adjunctive therapies.

Main Results:

  • ST is an infrequent but severe complication for both BMS and DES.
  • Over four years of follow-up in RCTs, no significant difference in overall ST frequency between DES and BMS was observed.
  • While overall rates are similar, a trend towards later ST occurrence with DES was noted, though no differences in mortality or myocardial infarction were found between stent types.

Conclusions:

  • ST remains a critical complication in PCI, necessitating ongoing research.
  • Current evidence suggests comparable overall ST rates between DES and BMS within four years, despite differing temporal patterns.
  • Further long-term follow-up and studies in broader patient populations are required to fully elucidate ST risks and optimize preventive strategies, including advancements in stent technology and pharmacotherapy.

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