Late thrombosis of paclitaxel-eluting stents:: Long-term incidence, clinical consequences, and risk factors in a cohort of 604 patients
Late thrombosis of paclitaxel-eluting stents:: Long-term incidence, clinical consequences, and risk factors in a cohort of 604 patients
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DOI：
10.1016/j.ahj.2007.11.027
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发表时间：
2008-04-01
影响因子：
4.8
通讯作者：
Castro-Beiras, Alfonso
中科院分区：
文献类型：
--
作者：
Flores-Rios, Xacobe;Marzoa-Rivas, Raquel;Castro-Beiras, Alfonso
背景晚期血栓形成是药物洗脱支架的主要安全性问题，但其在临床实践中的发生率至今仍存在争议，特别是支架植入后第一年。我们试图调查的发病率，临床后果，晚期血栓形成后药物洗脱支架implantation.Methods的对比患者（N = 604）谁收到>= 1紫杉醇洗脱支架（S）（PES）在2003年6月至2005年2月在我们的机构被纳入。临床特征和主要结果进行了审查，以检测晚期和极晚期明确PES血栓形成（LDT）的PES的情况下和预测因子，目前定义的学术研究理事会。结果在长期随访（中位数34.3个月，IQR 8.6），17例LDT（累积发病率2.8%，95%CI 1.7%-4.5%）。LDT多为极晚期血栓形成（14例，82%）。晚期和极晚期明确PES血栓形成的发生率稳定（发生率密度1.1%患者-年）。晚期和极晚期明确PES血栓形成与全因死亡（HR 3.2，95% CI 1.3-7.9）和心源性死亡（HR 6.0，95% CI 2.3-15.6）的高风险相关。撤回抗血小板治疗，左心室射血分数，平均支架直径每例患者的独立预测LDT在多变量analysis.Conclusions晚期和极晚期明确PES血栓形成可能是更频繁的在一个真实的设置比预期的初步实验和观察研究，但与最近的科学证据。在长期随访期间，其发生率似乎恒定，并且与总体和心源性死亡的高风险相关。
Background Late thrombosis is the major safety concern of drug-eluting stents, but its incidence in common clinical practice remains controversial to date, especially beyond the first year after stent implantation. We sought to investigate the incidence, clinical consequences, and risk factors of late thrombosis after drug-eluting stent implantation.Methods Consecutive patients (N = 604) who received >= 1 paclitaxel-eluting stent(s) (PES) between June 2003 and February 2005 at our institution were enrolled. Clinical characteristics and major outcomes were reviewed to detect cases and predictors of late and very late definite PES thrombosis (LDT) of PES, as currently defined by the Academic Research Council.Results During long-term follow-up (median 34.3 months, IQR 8.6), 17 cases of LDT were noted (cumulative incidence 2.8%, 95% CI 1.7%-4.5%). Most of LDT were very late thromboses (14 cases, 82%). Late and very late definite PES thrombosis appeared at a steady rate (incidence density 1.1 % patient-years). Late and very late definite PES thrombosis was related to a high risk of all-cause death (HR 3.2, 95 % CI 1.3-7.9) and cardiac death (HR 6.0, 95% C) 2.3-15.6). Withdrawal of antiplatelet therapy, left ventricular ejection fraction, and average stent diameter per patient were independent predictors of LDT in multivariate analysis.Conclusions Late and very late definite PES thrombosis may be more frequent in a real setting than anticipated by initial experimental and observational studies but is keeping with more recent scientific evidence. It seems to occur at a constant rate during long-term follow-up and is associated with a high risk of overall and cardiac death.