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Drug-eluting stent thrombosis: it's never too late

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 638–639 (2006)Cite this article

The initial trials of drug-eluting stents (DESs) demonstrated marked reductions in restenosis and the need for repeat revascularization procedures, and resulted in the near instantaneous adoption of this new therapy. In most instances, clinical decision-making during percutaneous coronary revascularization concerns not whether a DES will be used, but rather which type will be used and how many. Against the background of widespread enthusiasm for their use, however, DESs have presented an unexpected safety concern related to the potentially catastrophic occurrence of stent thrombosis. Although the frequency, predictors and clinical implications of stent thrombosis have been described for patients treated with conventional bare-metal stents (BMSs), this event is considerably less predictable with DESs and is characterized by a shift toward late stent thrombosis beyond 30 days following coronary revascularization.

Although the incidence of DES thrombosis is infrequent—case reports and observational studies describe an overall rate of <1.5%—this event could be more frequent in high-risk patient or lesion subsets,1 and the clinical and economic sequelae are substantial. Approximately 70% of patients with DES thrombosis experience myocardial infarction (MI), and mortality has ranged from 15% to 45%.1,2,3 In a recent study comparing outcomes for DESs versus BMSs, an increase of 3.3 cardiovascular deaths or MIs was observed with DESs for every 5 repeat revascularization events avoided.4 It is a strange irony, then, that a therapy intended to eliminate restenosis—an event that has been associated with the need for repeat revascularization procedures but not with increased mortality—might actually prove fatal in some instances.

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  1. the John B Simpson Assistant Professor of Interventional Cardiology and Genomic Sciences at the Duke Clinical Research Institute, Durham, NC, USA

    David E Kandzari

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  1. David E Kandzari
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Correspondence to David E Kandzari.

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The author has received research and grant support from the following organizations: Boston Scientific Corporation, Cordis Corporation, and Medtronic.

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Kandzari, D. Drug-eluting stent thrombosis: it's never too late. Nat Rev Cardiol 3, 638–639 (2006). https://doi.org/10.1038/ncpcardio0720

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