Adverse events beyond 1 year after percutaneous coronary intervention
Mahesh V Madhavan1,2, Gregg W Stone2,3
1NewYork-Presbyterian Hospital/Columbia University Irving Medical Center.
Current Opinion in Cardiology
|August 28, 2020
Summary
Coronary stents carry a persistent risk of major adverse cardiovascular events beyond one year post-procedure. Ongoing research into prevention and improved stent technology is vital for better patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Coronary artery disease management has advanced.
- Patients undergoing percutaneous coronary intervention (PCI) with coronary stents face long-term risks.
- Very late adverse events (>1 year) are a significant concern.
Purpose of the Study:
- To review and critically appraise literature on very late adverse events after PCI with coronary stents.
- To summarize current understanding of risks associated with coronary stents beyond the first year.
Main Methods:
- Pooled analysis of randomized trials.
- Network meta-analysis.
- Literature review and critical appraisal.
Main Results:
- All coronary stents, including drug-eluting stents (DES), pose an ongoing risk of major adverse cardiovascular events (MACE) related to the stented region.
- Annual MACE rates range from 2-3% for at least 4 years post-stenting.
- Patients are also at risk from new atherosclerotic disease in untreated segments.
Conclusions:
- Patients remain at risk for very late adverse cardiovascular events from both stented and untreated coronary segments.
- Advancements in primary prevention, stent design, procedural techniques, and secondary prevention are crucial.
- Reducing very late events will improve patient prognosis and symptoms after PCI.
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