Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Circulation. 2012 Mar 6;125(9):1110-21. doi: 10.1161/CIRCULATIONAHA.111.058560. Epub 2012 Feb 1.
Early-generation drug-eluting stents releasing sirolimus (SES) or paclitaxel (PES) are associated with increased risk of very late stent thrombosis occurring >1 year after stent implantation. It is unknown whether the risk of very late stent thrombosis persists with newer-generation everolimus-eluting stents (EES).
We assessed the risk of stent thrombosis in a cohort of 12 339 patients with unrestricted use of drug-eluting stents (3819 SES, 4308 PES, 4212 EES). Results are incidence rates per 100 person-years after inverse probability of treatment weighting to adjust for group differences. During follow-up of up to 4 years, the overall incidence rate of definite stent thrombosis was lower with EES (1.4 per 100 person-years) compared with SES (2.9; hazard ratio, 0.41; 95% confidence interval, 0.27-0.62; P<0.0001) and PES (4.4; hazard ratio, 0.33; 95% confidence interval, 0.23-0.48; P<0.0001). The incidence rate per 100 person-years of early (0-30 days), late (31 days-1 year), and very late stent thrombosis amounted to 0.6, 0.1, and 0.6 among EES-treated patients; 1.0, 0.3, and 1.6 among SES-treated patients; and 1.3, 0.7, and 2.4 among PES-treated patients. Differences in favor of EES were most pronounced beyond 1 year, with a hazard ratio of 0.33 (EES versus SES; P=0.006) and 0.34 (EES versus PES; P<0.0001). There was a lower risk of cardiac death or myocardial with EES compared with PES (hazard ratio, 0.65; 95% confidence interval, 0.56-0.75; P<0.0001), which was directly related to the lower risk of stent thrombosis-associated events (EES versus PES: hazard ratio, 0.36; 95% confidence interval, 0.23-0.57).
Current treatment with EES is associated with a lower risk of very late stent thrombosis compared with early-generation drug-eluting stents.
第一代药物洗脱支架（雷帕霉素洗脱支架[SES]或紫杉醇洗脱支架[PES]）释放的药物与支架植入 1 年后发生极晚期支架血栓形成的风险增加有关。尚不清楚新一代依维莫司洗脱支架（EES）是否会持续存在极晚期支架血栓形成的风险。
我们评估了 12339 例无限制使用药物洗脱支架（3819 例 SES、4308 例 PES、4212 例 EES）患者队列中支架血栓形成的风险。结果为经逆概率治疗加权后调整组间差异的每 100 人年的发生率。在长达 4 年的随访期间，EES（1.4/100 人年）的总体明确支架血栓形成发生率低于 SES（2.9；危险比，0.41；95%置信区间，0.27-0.62；P<0.0001）和 PES（4.4；危险比，0.33；95%置信区间，0.23-0.48；P<0.0001）。EES 治疗患者的早期（0-30 天）、晚期（31 天-1 年）和极晚期支架血栓形成的发生率分别为 0.6、0.1 和 0.6；SES 治疗患者分别为 1.0、0.3 和 1.6；PES 治疗患者分别为 1.3、0.7 和 2.4。EES 治疗的优势在 1 年以上最为明显，SES 与 SES 相比的危险比为 0.33（P=0.006），EES 与 PES 相比的危险比为 0.34（P<0.0001）。EES 治疗的心脏死亡或心肌梗死风险低于 PES（危险比，0.65；95%置信区间，0.56-0.75；P<0.0001），这与支架血栓形成相关事件风险较低直接相关（EES 与 PES 相比：危险比，0.36；95%置信区间，0.23-0.57）。
与第一代药物洗脱支架相比，目前 EES 的治疗与极晚期支架血栓形成的风险降低有关。
