Coronary stent thrombosis in the current drug-eluting stent era: insights from the ERACI III trial.

摘要

In recent years, the introduction (1) of drug-eluting stents (DES) during percutaneous coronary interventions (PCI) has been one of the major breakthroughs in interventional procedures. Several observational and randomized studies have shown a significantly lower restenosis rate with DES compared with bare-stent technology. Sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES) stents also substantially reduce the need for repeat revascularization procedures compared with standard stent technology. However, late safety outcome of these new devices is not well established. Late stent thrombosis, not seen in the first series of studies, has been recently reported and was associated with major adverse cardiac events. Even though a meta-analysis of randomized studies and registries confirmed the efficacy and safety of DES, these studies were not powered to detect any increase in late-stent thrombosis. Furthermore, in those studies, stent thrombosis (SET) was not equal and appropriately defined; more importantly, none of the cited studies included SET as a prespecified end point. Therefore, we sought to investigate the incidence of SET in a DES population included prospectively in the multicenter and controlled Argentine Randomized Trial of Coronary Stents versus Bypass Surgery (ERACI III) trial.