Le Feuvre C, Helft G, Cohen S, Batisse J-P, Barthélémy O, Collet J-P, Beygui F, Choussat R, Montalescot G, Metzger J-P
Institut de cardiologie, Département de cardiologie médicale, Groupe hospitalier Pitié-Salpêtrière, Paris.
Arch Cardiovasc Dis. 2008 Apr;101(4):220-5. doi: 10.1016/s1875-2136(08)73696-9.
Conflicting data exist on the risk of stent thrombosis with drug-eluting stents (DES) versus bare-metal stents (BMS). Little is known about the potential different characteristics and outcomes of DES versus BMS thrombosis.
To compare the characteristics, timing and outcomes of patients with angiographic stent thrombosis according to type of stent implanted.
The population comprised consecutive patients who underwent BMS or DES implantation (January 2003-April 2007) at Pitié-Salpêtrière Hospital. Data from patients with and without a stent thrombosis were compared to identify predictors of thrombosis. Timing of thrombosis (acute,<24 hours; subacute,<30 days; late,>30 days; very late,>1 year), clinical, angiographic and procedural characteristics, and outcomes were compared between patients with a BMS or DES thrombosis.
A total of 3579 patients received a BMS (2815 lesions, 2318 patients) or a DES (1536 lesions, 1261 patients). Documented angiographic stent thrombosis occurred in 52 (1.4%) patients, 16 (1.3%) with a DES and 36 (1.6%) with a BMS. Rates of acute (0.1% versus 0.2%), subacute (1% versus 0.7%), late (both 0.2%) and very late (both 0.2%) thrombosis were similar in patients with BMS and DES thrombosis. Factors predictive of stent thrombosis were similar, including left ventricular failure (P<0.0001), initial percutaneous coronary intervention (PCI) for acute myocardial infarction (P<0.0001), multivessel PCI (P<0.0001), and balloon dilatation before stenting (P<0.04). Eleven (21%) cases of BMS (n=8, 22%) or DES (n=3, 19%) thrombosis arose soon after stopping antiplatelet therapy. Thirteen of 52 (25%) patients died a few hours after the event. Twenty-seven (52%) major adverse cardiac events occurred at 18 months, 7 in patients with a DES and 20 in those with a BMS (44% versus 55%, P=NS). These included 16 deaths (31%), 7 repeat PCIs and 4 myocardial infarctions. There were no independent predictive factors of death after stent thrombosis.
BMS and DES thrombosis are similar in terms of timing of thrombosis, characteristics and outcomes, and share the same risk of late thrombosis after interruption of antiplatelet therapy.
关于药物洗脱支架（DES）与裸金属支架（BMS）相比，支架血栓形成风险的数据存在冲突。对于DES与BMS血栓形成潜在的不同特征和结果知之甚少。
根据植入支架的类型比较血管造影显示支架血栓形成患者的特征、发生时间和结果。
研究人群包括2003年1月至2007年4月在皮提耶-萨尔佩特里埃医院接受BMS或DES植入的连续患者。比较有和没有支架血栓形成患者的数据，以确定血栓形成的预测因素。比较BMS或DES血栓形成患者之间血栓形成的时间（急性，<24小时；亚急性，<30天；晚期，>30天；极晚期，>1年）、临床、血管造影和手术特征以及结果。
共有3579例患者接受了BMS（2815处病变，2318例患者）或DES（1536处病变，1261例患者）。记录到的血管造影支架血栓形成发生在52例（1.4%）患者中，DES组16例（1.3%），BMS组36例（1.6%）。BMS和DES血栓形成患者的急性（0.1%对0.2%）、亚急性（1%对0.7%）、晚期（均为0.2%）和极晚期（均为0.2%）血栓形成发生率相似。支架血栓形成的预测因素相似，包括左心室衰竭（P<0.0001）、急性心肌梗死的初始经皮冠状动脉介入治疗（PCI）（P<0.0001）、多支血管PCI（P<0.0001）以及支架置入前的球囊扩张（P<0.04）。11例（21%）BMS（n = 8，22%）或DES（n = 3，19%）血栓形成病例在停止抗血小板治疗后不久出现。52例患者中有13例（25%）在事件发生后数小时死亡。27例（52%）主要不良心脏事件发生在18个月时，DES组7例，BMS组20例（44%对55%，P=无显著性差异）。这些事件包括16例死亡（31%）、7例再次PCI和4例心肌梗死。支架血栓形成后死亡没有独立的预测因素。
BMS和DES血栓形成在血栓形成时间、特征和结果方面相似，并且在抗血小板治疗中断后晚期血栓形成的风险相同。
