Are drug-eluting stents associated with a higher rate of late thrombosis than bare metal stents? Late stent thrombosis: a nuisance in both bare metal and drug-eluting stents.

摘要

Late stent thrombosis (ST) is for us an old foe that we have tracked repeatedly throughout the history of interven-tional cardiology- In 1991, we made headlines by publishing in the New England Journal of Medicine a rate of early and late ST of 20% among the first 151 patients having received a wall stent. A few years later, when some believed that they had discovered the universal panacea for restenosis (vascular brachytherapy), we were the first to report in the literature 6 cases of late ST in 100 patients having undergone brachytherapy after stent implantation. At that time, this seminal observation triggered a wave of observations; the cases of late ST after brachytherapy accrued month after month until the pioneer in the field, Ron Waksman, courageously admitted in an editorial that we were "sitting on a time bomb." Five years later (2004), in the beginning of the drug-eluting stent (DES) era, we reported, together with Waksman's group, the first 4 cases of late ST.4 In the following 2 years, theincidence of late ST, scrutinized by alerted clinicians, was publicized in reports that included >25 000 patients treated with DES; the incidence ranged from 0.2% in a postmarketing surveillance trial to 1.8% in a small series of multivessel stenting.Around this period, we realized that Bern and Rotterdam had somewhat diverging incidences of late ST, 0.4% and 0.9%, and we joined efforts to retrospectively assess the rate of late ST over a period of 4 years. A steady rate of 0.6% per year was detected without abatement over a follow-up period of 3 years.