Regístrese
Buscar en
Revista Colombiana de Cardiología
Toda la web
Inicio Revista Colombiana de Cardiología Incidencia de trombosis de stents coronarios en el «mundo real»
Información de la revista
Vol. 17. Núm. 3.
Páginas 99-105 (Mayo - Junio 2010)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 17. Núm. 3.
Páginas 99-105 (Mayo - Junio 2010)
DOI: 10.1016/S0120-5633(10)70227-8
Open Access
Incidencia de trombosis de stents coronarios en el «mundo real»
Incidence of coronary stent thrombosis in the «real world»
Visitas
905
Bernardo Lombo1,
Autor para correspondencia
berlombo@yahoo.com

Correspondencia: Calle 116 No. 9-02 Piso 2. Bogotá, DC., Colombia. Teléfono (571) 6030303 ext.: 5061 - 5069.
, Iván Rendón1, Claudia Satizábal2, Carolina Rivas3, Daniel Sarmiento1, Carlos Carvajal1, Jorge Mor1, José G. Diez4
1 Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C, Colombia
2 Universidad de los Andes, Bogotá, D.C, Colombia
3 Epidemiología, Universidad El Bosque, Bogotá, D.C, Colombia
4 Baylor College of Medicine, Houston, Texas
Este artículo ha recibido
905
Visitas

Under a Creative Commons license
Información del artículo
Antecedentes

la evidencia disponible de stents liberadores de medicamento proviene de estudios controlados con estrictos criterios de inclusión, limitando sus conclusiones y haciendo difícil la aplicación de sus resultados en el mundo real.

Objetivo

determinar la incidencia de trombosis de stents liberadores y no liberadores de medicamento en pacientes del «mundo real».

Metodología

estudio de incidencia para determinar el número de casos de trombosis de stents implantados, mediante información obtenida a partir de historias clínicas, bases de datos y seguimiento clínico, y con base en características demográficas, factores de riesgo, consumo de clopidogrel y casos de trombosis del stent con un seguimiento de cero días a un año.

Resultados

640 stents implantados (69,2% no medicados, 30,8% medicados de los cuales 18,9% eran medicados con placlitaxel y 11,9% medicados con sirolimus). Se identificaron doce eventos de trombosis (siete stents medicados y cinco no medicados). La incidencia de trombosis con cualquier tipo de stent fue de 1,88% (IC 95% 0,97–3,28). La incidencia de trombosis con stent medicado fue 3,55% (IC 95% 1,43–7,32), y con stent no medicado 1,13% (IC 95% 0,37–2,64) p=0,000.

El riesgo relativo de trombosis con stent medicado es de 3,14 (IC 95% 1,01–9,78) p=0,037.

El riesgo relativo de presentar trombosis con stent medicado en infarto agudo del miocardio es 8,11 (IC 95% 2,32–28,31) p=0,001.

Conclusiones

la incidencia de trombosis del stent aumenta en el mundo real, y existe mayor riesgo de trombosis de stents medicados especialmente cuando son implantados en el contexto de un infarto agudo del miocardio.

Es necesario realizar estudios futuros que involucren una población de pacientes más amplia y con seguimiento a largo plazo.

Palabras clave:
trombosis
stents
cardiología intervencionista
Background

The existing evidence of drug-eluting stents comes from controlled studies done with strict inclusion criteria, limiting their conclusions and making difficult to apply their findings in the real world.

Objectives

determine the incidence of thrombosis between bare metal stents versus drugeluting stents in patients in the «real world»

Methods

incidence study to determine the number of cases of thrombosis in implanted stents through information gathered from clinical records, data bases and clinical follow-up, based on demographic characteristics, risk factors, clopidogrel treatment and events of stent thrombosis with a 0 days to 1 year follow-up.

Results

640 stents were implanted. 69.2% were bare metal stents and 30.8% drug-eluting stents, from which 18.9% were with placlitaxel and 11.9% with sirolimus. 12 thrombosis events were identified (7 with drug-eluting stents and 5 with bare metal stents). The incidence of thrombosis with any kind of stent was 1.88%(CI 95% 0.97–3.28). The incidence of thrombosis with drug-eluting stents was 3.55% (CI 95%1.43–7.32), and with bare metal stents 1.13% (CI 95% 0.37–2.64) p=0.000.

The relative risk of thrombosis with drug eluting stents is 3.14 (CI 95%1.01–9.78) p=0.037.

The relative risk of thrombosis with drug eluting stents and acute myocardial infarction is 8.11 (CI 95%2.32–28.31) p=0,001.

Conclusions

there is an increased incidence of thrombosis of coronary stents in the real world and a greater risk of thrombosis with drug eluting stents, especially when implanted in the context of an acute myocardial infarction.

It is necessary to conduct further studies that may involve a higher sample of patients population and long-term follow-up.

Key words:
thrombosis
stents
interventional cardiology
El Texto completo está disponible en PDF
Bibliografía
[1.]
E. Regar, P.A. Lemos, F. Saia, et al.
Incidence of thrombotic stent occlusion during the first three months after sirolimus-eluting stent implantation in 500 consecutive patients.
Am J Cardiol, 93 (2004), pp. 1271-1275
[2.]
D.E. Cutlip, D.S. Baim, K.K. Ho, et al.
Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials.
Circulation, 103 (2001), pp. 1967-1971
[3.]
A.T. Ong, A. Hoye, J. Aoki, et al.
Thirty-Day Incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation.
J Am Coll Cardiol, 45 (2004), pp. 948-953
[4.]
J.M. Hernández, V. Burgos, S. Gonzáles-Enríquez, et al.
Sirolimus-eluting stents to treta lesions with a high risk o restenosis. six-month clinical follow-up in the first 100 patients.
Rev Esp Cardiol, (2004), pp. 116-122
[5.]
D.W. Park, S.W. Park, S.W. Lee, et al.
Frequency of coronary arterial late angiographic stent thrombosis (LAST) in the first six months: outcomes with drug-eluting stents versus bare metal stents.
Am J Cardiol, 99 (2006), pp. 774-778
[6.]
B. Lagerqvist, S. James, U. Stenestrand, et al.
Long-term outcomes with drugeluting stents versus bare-metal stents in Sweden.
N Engl J Med, 356 (2007), pp. 1009-1019
[7.]
G. Stone, J. Moses, S. Ellis.
Safety and efficacy of sirolimus and paclitaxel-eluting coronary stents.
N Engl J Med, 356 (2007), pp. 998-1008
[8.]
C. Spaulding, J. Daemen, E. Boersma.
Pooled analysis of data comparing sirolimuseluting stents with bare-metal stents.
N Engl J Med, 356 (2007), pp. 989-997
[9.]
C. Spaulding, P. Henry, E. Teiger, et al.
Sirolimus-eluting versus uncoated stents in acute myocardial infarctation.
N Engl J Med, 355 (2006), pp. 1093-1104
[10.]
P.A. Lemos, F. Saia, A.H. Hofma, et al.
Short and long term clinical benefit of sirolimuseluting stents compared to convencional bare stents for patients with acute myocardial infarctation.
J Am Coll Cardiol, 43 (2004), pp. 704-708
[11.]
A. Kastrati, J. Mehilli, J. Pache.
Analysis of 14 trials comparing sirolimus- eluting stents with bare-metal stents.
N Engl J Med, 356 (2007), pp. 1030-1039
[12.]
D.H. Steinberg, S. Mishra, A. Javaid.
Comparison of effectiveness of bare metal stents versus drug-eluting stents in large (>3,5 mm) coronary arteries.
Am J Cardiol, 99 (2007), pp. 599-602
[13.]
P.W. Serruys, M.J. Kutryk, A.T. Ong.
Coronary-artery stents.
N Engl J Med, 354 (2006), pp. 483-495
[14.]
C. Roiron, P. Sánchez, A. Bouzamondo, P. Lechat, G. Montalescot.
Drug eluting stents: an updated meta-analysis of randomized controlled trials.
Heart, 92 (2006), pp. 641-649
[15.]
C. Indolfi, M. Pavia, I.F. Angelillo.
Drug-eluting stents versus bare metal stents in percutaneous coronary interventions (a meta-analysis).
Am J Cardiol, 95 (2005), pp. 1146-1152
[16.]
E. Schampert, E.A. Cohen, M. Schluter, et al.
The Canadian Study of the Sirolimus- Eluting Stent in the Treatment of Patients With Long De Novo Lesions in Small Native Coronary Arteries (C-Sirius).
J Am Coll Cardiol, 43 (2004), pp. 1110-1115
[17.]
L. Mauri, J. O'Malley, D.E. Cutlip, et al.
Effects of stent length and lesion length on coronary restenosis.
Am J Cardiol, 93 (2004), pp. 1340-1346
[18.]
S.J. Park, W.H. Shim, D.S. Ho, et al.
A paclitaxel-eluting stent for the prevention of coronary restenosis.
N Engl J Med, 348 (2003), pp. 1537-1545
[19.]
M. Sabate, P. Jiménez-Quevedo, D.J. Angiolino, et al.
Randomized comparison of sirolimus-eluting stent versus standart stent for percutaneous coronary revascularization in diabetic patients: The Diabetes and Sirolimus-Eluting Stent (DIABETES) Trial.
Circulation, 112 (2005), pp. 2175-2183
[20.]
L. Mauri, W. Hsieh, J. Massaro, et al.
Stent thrombosis in randomized clinical trials of drug-eluting stents.
N Engl J Med, 356 (2007), pp. 1020-1029
[21.]
Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet (in press).
[22.]
D.E. Cutlip, S. Windecker, R. Mehran, A. Boam, D.J. Cohen, G.A. van Es, Academic Research Consortium, et al.
Clinical end points in coronary stent trials: a case for standardized definitions.
Circulation, 115 (2007), pp. 2344-2351
Copyright © 2010. Socidad Colombiana de Cardiología y Cirugía Cardiovascular
Opciones de artículo
Herramientas
es en pt
Política de cookies Cookies policy Política de cookies
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.