Paper_Abstracts.qxp 11/10/07 15:46 Page 9
Paper Abstracts
A Selection of Recent Papers as Recommended by the Advisory Panel
Safety and Efficacy of Sirolimus- and Incidence and Predictors of Transcatheter Closure of Congenital
Paclitaxel-eluting Coronary Stents Drug-eluting Stent Thrombosis Ventricular Septal Defects –
Stone GW, Moses JW, et al. During and After Discontinuation of Results of the European Registry
N Engl J Med, 2007;356:998–1008. Thienopyridine Treatment Carminati M, Butera G, et al.
Following reports of increased stent thrombosis Airoldi F, Colombo A, et al. Eur Heart J, 2007;28(19):2361–8.
and myocardial infarction, the safety of drug- Circulation, 2007;116(7):745–54. This study aimed to report the experience of
eluting stents (DES) has recently been questioned. Key drawbacks linked to drug-eluting stents over 20 European referral centres on
Researchers performed pool analysis of data from (DES) include the need for prolonged aspirin transcatheter closure of congenital ventricular
four double-blind trials in which 1,748 patients and thienopyridine therapy along with the septal defects (VSDs). Implantation of
were randomly assigned to receive either risk of stent thrombosis (ST). This cohort transcatheter devices was attempted in 430
sirolimus-eluting stents (SES) or bare-metal stents study included over 3,021 patients successfully patients with VSDs. The following anatomical
(BMS), and from five double-blind trials in which treated in 5,389 lesions with DES. Detailed types were found: 119 muscular, 250 peri-
3,513 patients were randomly assigned to patient information was collected on membranous, 16 multiple and 45 residual post-
paclitaxel-eluting stents (PES) or BMS. Results antiplatelet therapy. Researchers analysed the surgery. The median VSD size was 7mm and
noted that four-year rates of stent thrombosis incidence of ST over an 18-month follow-up fluoroscopy time 33 minutes. Devices implanted
were 1.2% in the SES group versus 0.6% in the period. ST occurred in 1.9% of patients at 18 were Amplatzer muscular or membranous
BMS group and 1.3% in the PES group versus months, while 1.4% experienced the event devices in 364 patients, patent ductus arteriosus
0.9% in the BMS group. Notably, after 12 within six months of stent implantation. Acute (PDA) devices in 12 patients, atrial septal defect
months the study found five episodes of stent myocardial infarction occurred in 79% of (ASD) devices in seven patients, Starflex in seven
thrombosis in patients with SES versus none patients and death in 39% of patients with ST. patients and coils in nine patients. The
in patients with BMS, against nine episodes in The median interval from discontinuation of procedure was successful in 95% of cases.
patients with PES versus two in patients with thienopyridine therapy to ST was 13.5 days for Complications were noted with device
BMS. The study concluded that stent thrombosis the first six months and 90 days between six embolisation in five cases, aortic regurgitation in
after one year was more common with both SES and 18 months. On multivariable analysis, the 14 cases and tricuspid regurgitation in 27
and PES than with BMS. ■ strongest predictor for ST within six months of cases, Multivariate analysis highlighted that the
stenting was discontinuation of thienopyridine only variables associated with a risk of the
Impact of Platelet Reactivity after therapy. The study concluded that in the first occurrence of complication were age and
Clopidogrel Administration on six months, thienopyridine therapy was the weight. Factors for the development of
Drug-eluting Stent Thrombosis major determinant of ST. The study congenital atrioventricular block (cAVB) were
Buonamici P, Marcucci R, et al. highlighted, however, that insufficient device type and VSD location. The study
J Am Coll Cardiol, 2007;49(24):2312–17. information is available to determine whether concluded that transcatheter closure of
This study was designed to test whether non- there is benefit in continuing a thienopyridine congenital VSDs offers encouraging results and
responsiveness to clopidogrel as revealed by high beyond this period. ■ that complications are limited. ■
in vitro post-treatment platelet reactivity is
predictive of drug-eluting stent thrombosis.
A series of three review articles gives a complete update regarding the
Researchers conducted a cohort study in which
status of different drug-eluting stents in a variety of clinical settings:
804 patients who had experienced successful
sirolimus-eluting stent (SES) or paclitaxel-eluting Drug-eluting Stent Update 2007: Part I: A Survey of Current and Future
stent (PES) implantation were assessed for post- Generation Drug-eluting stents: Meaningful Advances or More of the Same?
treatment platelet reactivity after a loading dose Daemen J, Serruys PW, et al.
of 600mg of clopidogrel. The study end-point Circulation, 2007;116(3):316–28.
was the incidence of definite/probable early,
Drug-eluting Stent Update 2007: Part II: Unsettled Issues
subacute and late stent thrombosis after a six-
Daemen J, Serruys PW, et al.
month follow-up. The study revealed that
Circulation, 2007;116(8):961–8.
incidence of definite/probable stent thrombosis
was 3.1%. Fifteen per cent of patients were not
Drug-eluting Stent Update 2007: Part III: Technique and Unapproved/
responsive to clopidogrel. A stent thrombosis
Unsettled Indications (Left Main, Bifurcations, Total Occlusions, Small
incidence of 8.6% was recorded in non-
Vessels and Long Lesions, Saphenous Vein Grafts, Acute Myocardial
responders and of 2.3% in responders. The study
Infarctions, and Multivessel Disease)
concluded that non-responsiveness to clopidogrel
Colombo A, Chieffo A, et al.
is a strong independent predictor of stent
Circulation, 2007;116:1424–32.
thrombosis in patients receiving SES or PES. ■
© TOUCH BRIEFINGS 2007 9
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