Very Late Coronary Stent Thrombosis of a Newer-Generation Everolimus-Eluting Stent Compared With Early-Generation Drug-Eluting Stents

Background— Early-generation drug-eluting stents releasing sirolimus (SES) or paclitaxel (PES) are associated with increased risk of very late stent thrombosis occurring >1 year after stent implantation. It is unknown whether the risk of very late stent thrombosis persists with newer-generation everolimus-eluting stents (EES). Methods and Results— We assessed the risk of stent thrombosis in a cohort of 12 339 patients with unrestricted use of drug-eluting stents (3819 SES, 4308 PES, 4212 EES). Results are incidence rates per 100 person-years after inverse probability of treatment weighting to adjust for group differences. During follow-up of up to 4 years, the overall incidence rate of definite stent thrombosis was lower with EES (1.4 per 100 person-years) compared with SES (2.9; hazard ratio, 0.41; 95% confidence interval, 0.27–0.62; P <0.0001) and PES (4.4; hazard ratio, 0.33; 95% confidence interval, 0.23–0.48; P <0.0001). The incidence rate per 100 person-years of early (0–30 days), late (31 days–1 year), and very late stent thrombosis amounted to 0.6, 0.1, and 0.6 among EES-treated patients; 1.0, 0.3, and 1.6 among SES-treated patients; and 1.3, 0.7, and 2.4 among PES-treated patients. Differences in favor of EES were most pronounced beyond 1 year, with a hazard ratio of 0.33 (EES versus SES; P =0.006) and 0.34 (EES versus PES; P <0.0001). There was a lower risk of cardiac death or myocardial with EES compared with PES (hazard ratio, 0.65; 95% confidence interval, 0.56–0.75; P <0.0001), which was directly related to the lower risk of stent thrombosis–associated events (EES versus PES: hazard ratio, 0.36; 95% confidence interval, 0.23–0.57). Conclusion— Current treatment with EES is associated with a lower risk of very late stent thrombosis compared with early-generation drug-eluting stents.