The Bern-Rotterdam analysis, one of three major studies looking at the phenomena of stent thrombosis in Drug Eluting Stents (DES) has been published in the February 24 issue of The Lancet. The study looked at late-stent thrombosis rates (>30 days after stenting) from 2002 to 2005 for Sirolimus-Eluting Stents (SES) and Paclitaxel-Eluting Stents (PES).
8146 patients underwent stenting at hospitals that adopted policies of 100% DES use with SES ( 3823 patients) and PES (4323 patients). A total of 152 angiographically documented stent thromboses occurred, of which 61 were late-stent thromboses. The rate of stent thrombosis was 1.3 per 100 person-years with a cumulative incidence of 2.9%.
Rates of early-stent thrombosis were similar for the SES and PES but were more common in PES-treated patients (1.8% vs 1.4%). The authors cautioned that the rates for the 2 stents cannot accurately be compared since PES tended to be used in more complex lesions and follow-up in these patients was not as long as it was for the SES patients.
Of note was the fact that 87% taking dual antiplatelet therapy (aspirin and Plavix) experienced early stent thrombosis (<30>
Two unanswered questions remain.
1. Is the higher risk of DES stent thrombosis offset by the reduced risk of stent restenosis as compared to bare metal stents (BMS)?
2. What critieria could more effectively conclude which patients would be better off using DES versus BMS.
If nothing else, two conclusions can also be drawn.
1. We have begun to quantify DES risks so we will soon have metrics to compare different DES technologies versus BMS and under what circumstances each provides the best outcome.
2. It is still better to prevent heart disease using a proactive approach such as heart scans, lipoprotein analysis, and proper preventive measures than to wait until a stent is the only option.