Issue: October 2011
October 01, 2011
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Newer-generation everolimus-eluting stent reduced definite stent thrombosis

Issue: October 2011
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European Society of Cardiology Congress 2011

Definite stent thrombosis was reduced during long-term follow-up with a newer-generation everolimus-eluting stent vs. an early-generation drug-eluting stent, new study results indicated.

The Bern-Rotterdam cohort study treated 12,339 patients for stent thrombosis with drug-eluting stents, everolimus-eluting stents (EES), paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) between 2002 and 2009, with a follow-up of 2.9 years. Researchers reported results as cumulative incidence per 100 person-years, and inverse probability of treatment weight was used to weigh hazards to adjust for group differences. Results of the trial were presented at the European Society of Cardiology Congress 2011 in Paris.

Follow-up was conducted for up to 4 years; patients treated with EES had a lower rate of stent thrombosis vs. PES and SES over that period.

“The near elimination of stent thrombosis observed between 1 and 4 years after implantation shows that EES overcome the principal limitation of early-generation DES,” Lorenz Raber, MD, of the University Hospital of Bern in Switzerland, said in a press release. “This is an important advance in the safety of DES.”

Cumulative incidence in EES for early (0.6%), late (0.1%) and very late (0.6%) stent thrombosis was lower than in SES (1%, 0.3%, and 1.6%) and PES (1.3%, 0.7%, and 2.4%). Very late stent thrombosis had a risk reduction of 67% when comparing EES and SES vs. 76% when comparing EES and PES. Cardiac death or MI trends showed lower risks in patients treated with EES vs. SES, and a significant reduction in patients treated with EES vs. PES. Researchers found that EES treatments were directly related to lower risk of stent thrombosis associated events.

“For the first time, we now have robust evidence of the long-term therapeutic benefit of newer-generation DES over the early-generation DES,” Raber said. “The virtual elimination of very late stent thrombosis in our findings provides reassurance of the long-term safety of these devices.”

For more information:

Disclosure: The Bern-Rotterdam cohort received grants from CTU Bern and the Swiss National Science Foundation.

PERSPECTIVE

Newer-generation DES have been developed to improve the safety profile by means of more biocompatible polymers, reduced drug dose with adapted release kinetics and reduced strut thickness. Benefits in favor of EES were most pronounced during the very late period, greater than 1 year, and differences in favor of EES were large and consistent across major subgroups.

– Jean Fajadet, MD
President of EAPCI, Clinique Pasteur, Toulouse, France

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