Key result
Drug-eluting stents were associated with a higher risk of late acquired stent malapposition compared with bare-metal stents (OR 4.36; 95% CI 1.74-10.94), which associated with late stent thrombosis.
Why the study?
Does drug-eluting stent implantation increase the risk of late acquired stent malapposition compared with bare-metal stents?
Meta-Analysis
Does drug-eluting stent implantation increase the risk of late acquired stent malapposition compared with bare-metal stents?
Drug-eluting stents are associated with a four-fold higher risk of late acquired stent malapposition compared to bare-metal stents, which correlates with an increased risk of late stent thrombosis.
Answers are grounded in this paper and cite their sources.
Alerts clinicians to elevated late thrombosis risk with drug-eluting stents; confirms malapposition link but leaves optimal prevention open.
AIMS: Late stent malapposition (LSM) may be acquired (LASM) or persistent. LSM may play a role in patients who develop late stent thrombosis (ST). Our objective was to compare the risk of LASM in bare metal stents (BMS) with drug-eluting stents (DES) and to investigate the possible association of both acquired and persistent LSM with (very) late ST. METHODS AND RESULTS: We searched PubMed and relevant sources from January 2002 to December 2007. Inclusion criteria were: (a) intra-vascular ultrasonography (IVUS) at both post-stent implantation and follow-up; (b) 6-9-month-follow-up IVUS; (c) implantation of either BMS or the following DES: sirolimus, paclitaxel, everolimus, or zotarolimus; and (d) follow-up for LSM. Of 33 articles retrieved for detailed evaluation, 17 met the inclusion criteria. The risk of LASM in patients with DES was four times higher compared with BMS (OR = 4.36, CI 95% 1.74-10.94) in randomized clinical trials. The risk of (very) late ST in patients with LSM (five studies) was higher compared with those without LSM (OR = 6.51, CI 95% 1.34-34.91). CONCLUSION: In our meta-analysis, the risk of LASM is strongly increased after DES implantation compared with BMS. Furthermore, LSM seems to be associated with late and very late ST.
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Hassan et al. (2009) conducted a meta-analysis in Late stent malapposition and late stent thrombosis. Drug-eluting stents (DES) vs. Bare metal stents (BMS) was evaluated on Late acquired stent malapposition (LASM) (OR 4.36, 95% CI 1.74-10.94). Drug-eluting stents were associated with a higher risk of late acquired stent malapposition compared with bare-metal stents (OR 4.36; 95% CI 1.74-10.94), which associated with late stent thrombosis.
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