Risk Factors for Stent Thrombosis After Implantation of Sirolimus-eluting Stents in Diabetic and Nondiabetic Patients: the Evastent Matched-cohort Registry.
From: CHU Michallon, Grenoble, France. jmachecourt@chu-grenoble.fr
Journal of the American College of Cardiology
- Publish Date: Aug 2007
- ISSN: 1558-3597
- Volume: 50
- Issue: 6
- Pages: 501-8
- Medium: Internet
- Language: English
- Citation (JAMA): Machecourt Jacques, Danchin Nicolas, Lablanche Jean Marc, et al. Risk Factors for Stent Thrombosis After Implantation of Sirolimus-eluting Stents in Diabetic and Nondiabetic Patients: the Evastent Matched-cohort Registry.. J. Am. Coll. Cardiol. Aug 2007;50:501-8
Abstract
OBJECTIVES: We sought to assess the frequency and causes of stent thrombosis in diabetic and nondiabetic patients after implantation of sirolimus-eluting stents. BACKGROUND: Safety concerns about late stent thrombosis have been raised, particularly when drug-eluting stents are used in less highly selected patients than in randomized trials. METHODS: The EVASTENT study is a matched multicenter cohort registry of 1,731 patients undergoing revascularization exclusively with sirolimus stents; for each diabetic patient included (stratified as single- or multiple-vessel disease), a nondiabetic patient was subsequently included. Patients were treated with aspirin + clopidogrel for at least 3 months and were followed for 465 (range 0 to 1,062) days (1-year follow-up in 98.5%). The primary end point was a composite of stent thrombosis (according to Academic Research Consortium definitions), cardiovascular death, and nonfatal myocardial infarction (major adverse cardiac events [MACE]). RESULTS: During follow-up, MACE occurred in 78 patients (4.5%), cardiac death in 35 (2.1%), and stent thrombosis in 45 (2.6%): 30 definite, 23 subacute, and 22 late, including 9 at >6 months. In univariate analysis, the 1-year stent thrombosis rate was 1.8 times higher in diabetic than in nondiabetic patients (3.2% vs. 1.7%; log rank p = 0.03), with diabetic patients with multiple-vessel disease experiencing the highest rate and nondiabetic single-vessel disease patients the lowest (4.3% vs. 0.8%; p < 0.001). In multivariate analysis, in addition to the interruption of antithrombotic treatment, independent stent thrombosis predictors were previous stroke, renal failure, lower ejection fraction, calcified lesion, length stented, and insulin-requiring diabetes. CONCLUSIONS: The risk of sirolimus stent thrombosis is higher for multiple-vessel disease diabetic patients.
Mesh Headings (Keywords): Aged, Angioplasty, Transluminal, Percutaneous Coronary, Antibiotics, Antineoplastic, Blood Vessel Prosthesis Implantation, Case-Control Studies, Coronary Disease, Diabetic Angiopathies, Disease-Free Survival, Drug Delivery Systems, Female, Humans, Insulin, Male, Middle Aged, Prospective Studies, Registries, Risk Factors, Sirolimus, Stents, Thrombosis, Treatment Outcome
Check for Full Text / PubMed Unique Identifier (PMID): 17678732
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