Herz

, Volume 36, Issue 3, pp 241–253 | Cite as

Koronare Stent-Thrombosen

Was gibt es Neues für 2011?
Schwerpunkt/CME

Zusammenfassung

Stent-Thrombosen (ST) stellen eine schwerwiegende Komplikation der perkutanen Behandlung der koronaren Herzkrankheit dar und sind mit einer hohen Sterblichkeitsrate von bis zu 45% verbunden. Bare-Metal-Stents (BMS) und Drug-Eluting-Stents (DES) haben eine ähnliche Inzidenz für frühe (0,6–1,2%) und späte (0,3–0,4%) ST. Sehr späte ST (über 1 Jahr nach Stent-Implantation) weisen einen unabhängigen pathogenetischen Mechanismus auf und werden fast ausschließlich nach der Implantation von DES der 1. Generation mit einer Rate von 0,6% Ereignissen/Jahr beobachtet. Starke Determinanten für das Auftreten früher und später ST sind eine unzureichende Thrombozytenaggregationshemmertherapie, ein akutes Koronarsyndrom, Auftreten von Komplikationen während des Eingriffs, das unmittelbare postprozedurale Resultat sowie Begleiterkrankungen des Patienten. Sehr späte ST haben eine eigenständige Pathogenese – eine direkt medikamentös bedingte Hemmung der Reendothelialisierung und eine durch das Medikament oder das Polymer des Stent verursachte chronische Entzündung der Gefäßwand mit in der Folge gestörter Reendothelialisierung, welche zu einem positivem Remodelling der Arterienwand mit sekundärer Malapposition des Stent führt. In der Prävention der ST spielt die duale Thrombozytenaggregationshemmertherapie eine zentrale Rolle. Das vorzeitige Absetzen dieser Therapie in den ersten 6 Monaten nach Stent-Implantation führt zu einer erhöhten Inzidenz von ST. Zur Prävention gehört auch der Fortschritt. Erfreulicherweise haben die Verwendung von DES der 2. Generation und neue Thrombozytenaggregationshemmertherapien die Inzidenz der ST signifikant verringert.

Schlüsselwörter

Stent-Thrombose Medikamentenfreisetzender Stent Myokardinfarkt Determinanten 

Coronary stent thrombosis

What’s new in 2011?

Abstract

Stent thrombosis (ST) is a serious complication of percutaneous coronary interventions (PCI) with high mortality rates of up to 45%. Bare metal stents (BMS) and drug-eluting stents (DES) present similar rates of early (0.6%–1.2%) and late (0.3%–0.4%) ST. Very late ST is a specific entity after implantation of first-generation DES (sirolimus and paclitaxel) with an observed rate at 0.6% events/year. Strong predictors for early and late ST include: inadequate platelet inhibition, acute coronary syndromes (ACS), procedure-related factors such as stent underexpansion or dissection and patient-related factors such as diabetes, renal failure or a low left ventricular ejection fraction. Very late ST has been associated with delayed endothelial healing and drug-induced hypersensitivity reaction with exaggerated positive vessel remodeling, secondary incomplete stent apposition and paradoxical vasoconstriction. Dual antiplatelet therapy plays a key role in the prevention of ST. Premature dual antiplatelet therapy interruption (<6 months after PCI) and clopidogrel resistance (25% of patients) are strongly associated with ST. Finally, promising new pharmacologic agents such as prasugrel and ticagrelor have been introduced, permitting more predictable inhibition of platelet aggregation and enabling a further reduction in ST risk.

Keywords

Stent thrombosis Drug-eluting stent Myocardial infarction Predictors 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Sigwart U et al (1987) Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med 316(12):701–706PubMedCrossRefGoogle Scholar
  2. 2.
    Serruys PW et al (1991) Angiographic follow-up after placement of a self-expanding coronary-artery stent. N Engl J Med 324(1):13–17PubMedCrossRefGoogle Scholar
  3. 3.
    Roubin GS et al (1992) Intracoronary stenting for acute and threatened closure complicating percutaneous transluminal coronary angioplasty. Circulation 85(3):916–927PubMedGoogle Scholar
  4. 4.
    Foley JB, Brown RI, Penn IM (1994) Thrombosis and restenosis after stenting in failed angioplasty: comparison with elective stenting. Am Heart J 128(1):12–20PubMedCrossRefGoogle Scholar
  5. 5.
    Serruys PW et al (1994) A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med 331(8):489–495PubMedCrossRefGoogle Scholar
  6. 6.
    Fischman DL et al (1994) A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med 331(8):496–501PubMedCrossRefGoogle Scholar
  7. 7.
    Cohen DJ et al (1995) In-hospital and one-year economic outcomes after coronary stenting or balloon angioplasty. Results from a randomized clinical trial. Stent Restenosis Study Investigators. Circulation 92(9):2480–2487PubMedGoogle Scholar
  8. 8.
    Leon MB et al (1998) A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med 339(23):1665–1671PubMedCrossRefGoogle Scholar
  9. 9.
    Serruys PW, Kutryk MJ, Ong AT (2006) Coronary-artery stents. N Engl J Med 354(5):483–495PubMedCrossRefGoogle Scholar
  10. 10.
    Daemen J et al (2007) 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 369(9562):667–678PubMedCrossRefGoogle Scholar
  11. 11.
    Cutlip DE et al (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115(17):2344–2351PubMedCrossRefGoogle Scholar
  12. 12.
    Ong AT et al (2005) 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(6):947–953PubMedCrossRefGoogle Scholar
  13. 13.
    Bavry AA et al (2005) What is the risk of stent thrombosis associated with the use of paclitaxel-eluting stents for percutaneous coronary intervention? A meta-analysis. J Am Coll Cardiol 45(6):941–946PubMedCrossRefGoogle Scholar
  14. 14.
    Bavry AA et al (2005) Risk of thrombosis with the use of sirolimus-eluting stents for percutaneous coronary intervention (from registry and clinical trial data). Am J Cardiol 95(12):1469–1472PubMedCrossRefGoogle Scholar
  15. 15.
    Stettler C et al (2007) Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 370(9591):937–948PubMedCrossRefGoogle Scholar
  16. 16.
    Mauri L et al (2007) Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med 356(10):1020–1029PubMedCrossRefGoogle Scholar
  17. 17.
    Stone GW et al (2007) Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. N Engl J Med 356(10):998–1008PubMedCrossRefGoogle Scholar
  18. 18.
    Roukoz H et al (2009) Comprehensive meta-analysis on drug-eluting stents versus bare-metal stents during extended follow-up. Am J Med 122(6):581 e1–e10PubMedCrossRefGoogle Scholar
  19. 19.
    Wenaweser P et al (2008) Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study. J Am Coll Cardiol 52(14):1134–1140PubMedCrossRefGoogle Scholar
  20. 20.
    Kastrati A et al (2007) Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med 356(10):1030–1039PubMedCrossRefGoogle Scholar
  21. 21.
    Kirtane AJ et al (2009) Safety and efficacy of drug-eluting and bare metal stents: comprehensive meta-analysis of randomized trials and observational studies. Circulation 119(25):3198–3206PubMedCrossRefGoogle Scholar
  22. 22.
    Stone GW et al (2010) Everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease. N Engl J Med 362(18):1663–1674PubMedCrossRefGoogle Scholar
  23. 23.
    Kedhi E et al (2010) Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice (COMPARE): a randomised trial. Lancet 375(9710):201–209PubMedCrossRefGoogle Scholar
  24. 24.
    Leon MB et al (2010) Improved late clinical safety with zotarolimus-eluting stents compared with paclitaxel-eluting stents in patients with de novo coronary lesions: 3-year follow-up from the ENDEAVOR IV (Randomized comparison of zotarolimus- and paclitaxel-eluting stents in patients with coronary artery disease) trial. JACC Cardiovasc Interv 3(10):1043–1050PubMedCrossRefGoogle Scholar
  25. 25.
    Mauri L et al (2010) Long-term clinical outcomes with zotarolimus-eluting versus bare-metal coronary stents. JACC Cardiovasc Interv 3(12):1240–1249PubMedCrossRefGoogle Scholar
  26. 26.
    Meredith I et al (2010) Extended follow-up safety and effectiveness of the endeavor zotarolimus-eluting stent in real-world clinical practice: two-year follow-up from the E-Five Registry. Catheter Cardiovasc Interv [Epub ahead of print]Google Scholar
  27. 27.
    Ormiston JA et al (2010) Six-month results of the NEVO Res-Elution I (NEVO RES-I) trial: a randomized, multicenter comparison of the NEVO sirolimus-eluting coronary stent with the TAXUS Liberte paclitaxel-eluting stent in de novo native coronary artery lesions. Circ Cardiovasc Interv 3(6):556–564PubMedCrossRefGoogle Scholar
  28. 28.
    Werkum JW van et al (2009) Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry. J Am Coll Cardiol 53(16):1399–1409PubMedCrossRefGoogle Scholar
  29. 29.
    Torre-Hernandez JM de la et al (2008) Drug-eluting stent thrombosis: results from the multicenter Spanish registry ESTROFA (Estudio ESpanol sobre TROmbosis de stents FArmacoactivos). J Am Coll Cardiol 51(10):986–990PubMedCrossRefGoogle Scholar
  30. 30.
    Iakovou I et al (2005) Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 293(17):2126–2130PubMedCrossRefGoogle Scholar
  31. 31.
    Aoki J et al (2009) Early stent thrombosis in patients with acute coronary syndromes treated with drug-eluting and bare metal stents: the Acute Catheterization and Urgent Intervention Triage Strategy trial. Circulation 119(5):687–698PubMedCrossRefGoogle Scholar
  32. 32.
    Cutlip DE et al (2001) Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 103(15):1967–1971PubMedGoogle Scholar
  33. 33.
    Uren NG et al (2002) Predictors and outcomes of stent thrombosis: an intravascular ultrasound registry. Eur Heart J 23(2):124–132PubMedCrossRefGoogle Scholar
  34. 34.
    Orford JL et al (2002) Frequency and correlates of coronary stent thrombosis in the modern era: analysis of a single center registry. J Am Coll Cardiol 40(9):1567–1572PubMedCrossRefGoogle Scholar
  35. 35.
    Fujii K et al (2005) Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J Am Coll Cardiol 45(7):995–998PubMedCrossRefGoogle Scholar
  36. 36.
    Cook S, Windecker S (2009) Early stent thrombosis: past, present, and future. Circulation 119(5):657–659PubMedCrossRefGoogle Scholar
  37. 37.
    Kuchulakanti PK et al (2006) Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents. Circulation 113(8):1108–1113PubMedCrossRefGoogle Scholar
  38. 38.
    Airoldi F et al (2007) Incidence and predictors of drug-eluting stent thrombosis during and after discontinuation of thienopyridine treatment. Circulation 116(7):745–754PubMedCrossRefGoogle Scholar
  39. 39.
    Park SJ et al (2010) Duration of dual antiplatelet therapy after implantation of drug-eluting stents. N Engl J Med 362(15):1374–1382PubMedCrossRefGoogle Scholar
  40. 40.
    Lasala JM et al (2009) Drug-eluting stent thrombosis in routine clinical practice: two-year outcomes and predictors from the TAXUS ARRIVE registries. Circ Cardiovasc Interv 2(4):285–293PubMedCrossRefGoogle Scholar
  41. 41.
    Park DW et al (2006) Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Am J Cardiol 98(3):352–356PubMedCrossRefGoogle Scholar
  42. 42.
    Kimura T et al (2010) Comparisons of baseline demographics, clinical presentation, and long-term outcome among patients with early, late, and very late stent thrombosis of sirolimus-eluting stents: observations from the Registry of Stent Thrombosis for Review and Reevaluation (RESTART). Circulation 122(1):52–61PubMedCrossRefGoogle Scholar
  43. 43.
    Joner M et al (2006) Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 48(1):193–202PubMedCrossRefGoogle Scholar
  44. 44.
    Virmani R et al (2004) Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious? Circulation 109(6):S 701–705CrossRefGoogle Scholar
  45. 45.
    Awata M et al (2007) Serial angioscopic evidence of incomplete neointimal coverage after sirolimus-eluting stent implantation: comparison with bare-metal stents. Circulation 116(8):910–916PubMedCrossRefGoogle Scholar
  46. 46.
    Matsumoto D et al (2007) Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography. Eur Heart J 28(8):961–967PubMedCrossRefGoogle Scholar
  47. 47.
    Finn AV et al (2007) Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 115(18):2435–2441PubMedCrossRefGoogle Scholar
  48. 48.
    Katoh H et al (2009) Delayed neointimalization on sirolimus-eluting stents: 6-month and 12-month follow up by optical coherence tomography. Circ J 73(6):1033–1037PubMedCrossRefGoogle Scholar
  49. 49.
    Cook S et al (2009) Correlation of intravascular ultrasound findings with histopathological analysis of thrombus aspirates in patients with very late drug-eluting stent thrombosis. Circulation 120(5):391–399PubMedCrossRefGoogle Scholar
  50. 50.
    Cook S et al (2007) Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation 115(18):2426–2434PubMedCrossRefGoogle Scholar
  51. 51.
    Feres F, Costa JR Jr, Abizaid A (2006) Very late thrombosis after drug-eluting stents. Catheter Cardiovasc Interv 68(1):83–88PubMedCrossRefGoogle Scholar
  52. 52.
    Togni M et al (2005) Sirolimus-eluting stents associated with paradoxic coronary vasoconstriction. J Am Coll Cardiol 46(2):231–236PubMedCrossRefGoogle Scholar
  53. 53.
    Togni M et al (2007) Local vascular dysfunction after coronary paclitaxel-eluting stent implantation. Int J Cardiol 120(2):212–220PubMedCrossRefGoogle Scholar
  54. 54.
    Nakazawa G et al (2009) One step forward and two steps back with drug-eluting-stents: from preventing restenosis to causing late thrombosis and nouveau atherosclerosis. JACC Cardiovasc Imaging 2(5):625–628PubMedCrossRefGoogle Scholar
  55. 55.
    Guagliumi G, Costa MA, Sirbu V et al (2011) Strut coverage and late malapposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: optical coherence tomography substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial. Circulation 123(3):274–281PubMedCrossRefGoogle Scholar
  56. 56.
    Steffel J et al (2005) Rapamycin, but not FK-506, increases endothelial tissue factor expression: implications for drug-eluting stent design. Circulation 112(13):2002–2011PubMedCrossRefGoogle Scholar
  57. 57.
    Stahli BE et al (2006) Paclitaxel enhances thrombin-induced endothelial tissue factor expression via c-Jun terminal NH2 kinase activation. Circ Res 99(2):149–155PubMedCrossRefGoogle Scholar
  58. 58.
    Wenaweser P, Hess O (2005) Stent thrombosis is associated with an impaired response to antiplatelet therapy. J Am Coll Cardiol 46(5):CS5–CS6PubMedGoogle Scholar
  59. 59.
    Doyle B et al (2007) Outcomes of stent thrombosis and restenosis during extended follow-up of patients treated with bare-metal coronary stents. Circulation 116(21):2391–2398PubMedCrossRefGoogle Scholar
  60. 60.
    Burzotta F et al (2008) Angiographic and clinical outcome of invasively managed patients with thrombosed coronary bare metal or drug-eluting stents: the OPTIMIST study. Eur Heart J 29(24):3011–3021PubMedCrossRefGoogle Scholar
  61. 61.
    Ong AT et al (2005) Late angiographic stent thrombosis (LAST) events with drug-eluting stents. J Am Coll Cardiol 45(12):2088–2092PubMedCrossRefGoogle Scholar
  62. 62.
    Werkum JW van et al (2009) Long-term clinical outcome after a first angiographically confirmed coronary stent thrombosis: an analysis of 431 cases. Circulation 119(6):828–834PubMedCrossRefGoogle Scholar
  63. 63.
    Lemesle G et al (2008) High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis. Catheter Cardiovasc Interv 72(4):470–478PubMedCrossRefGoogle Scholar
  64. 64.
    Porto I et al (2010) Angiographic predictors of recurrent stent thrombosis (from the Outcome of PCI for stent-ThrombosIs MultIcentre STudy [OPTIMIST]). Am J Cardiol 105(12):1710–1715PubMedCrossRefGoogle Scholar
  65. 65.
    Mehta SR et al (2001) Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 358(9281):527–533PubMedCrossRefGoogle Scholar
  66. 66.
    Yusuf S et al (2001) Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 345(7):494–502PubMedCrossRefGoogle Scholar
  67. 67.
    Sabatine MS et al (2005) Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. JAMA 294(10):1224–1232PubMedCrossRefGoogle Scholar
  68. 68.
    Wiviott SD et al (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357(20):2001–2015PubMedCrossRefGoogle Scholar
  69. 69.
    Wallentin L et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361(11):1045–1057PubMedCrossRefGoogle Scholar
  70. 70.
    Chen KY et al (2009) Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Circulation 119(25):3207–3214PubMedCrossRefGoogle Scholar
  71. 71.
    Wijns W et al (2010) Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 31(20):2501–2555PubMedCrossRefGoogle Scholar
  72. 72.
    King SB 3rd et al (2008) 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee. Circulation 117(2):261–295PubMedCrossRefGoogle Scholar
  73. 73.
    Pfisterer M et al (2006) Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents. J Am Coll Cardiol 48(12):2584–2591PubMedCrossRefGoogle Scholar
  74. 74.
    Eisenstein EL et al (2007) Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA 297(2):159–168PubMedCrossRefGoogle Scholar
  75. 75.
    Ferreira-Gonzalez I et al (2010) Background, incidence, and predictors of antiplatelet therapy discontinuation during the first year after drug-eluting stent implantation. Circulation 122(10):1017–1025PubMedCrossRefGoogle Scholar
  76. 76.
    Ferrari E et al (2005) Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis. J Am Coll Cardiol 45(3):456–459PubMedCrossRefGoogle Scholar
  77. 77.
    Cuisset T et al (2009) Aspirin noncompliance is the major cause of „aspirin resistance“ in patients undergoing coronary stenting. Am Heart J 157(5):889–893PubMedCrossRefGoogle Scholar
  78. 78.
    Roy P et al (2008) Impact of „nuisance“ bleeding on clopidogrel compliance in patients undergoing intracoronary drug-eluting stent implantation. Am J Cardiol 102(12):1614–1617PubMedCrossRefGoogle Scholar
  79. 79.
    Vicenzi MN et al (2006) Coronary artery stenting and non-cardiac surgery – a prospective outcome study. Br J Anaesth 96(6):686–693PubMedCrossRefGoogle Scholar
  80. 80.
    Smith SC Jr et al (2006) ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 113(7):e166–e286PubMedCrossRefGoogle Scholar
  81. 81.
    Patrono C et al (2005) Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med 353(22):2373–2383PubMedCrossRefGoogle Scholar
  82. 82.
    Fontana P et al (2006) Biological effects of aspirin and clopidogrel in a randomized cross-over study in 96 healthy volunteers. J Thromb Haemost 4(4):813–819PubMedCrossRefGoogle Scholar
  83. 83.
    Frelinger AL 3rd et al (2006) Residual arachidonic acid-induced platelet activation via an adenosine diphosphate-dependent but cyclooxygenase-1- and cyclooxygenase-2-independent pathway: a 700-patient study of aspirin resistance. Circulation 113(25):2888–2896PubMedCrossRefGoogle Scholar
  84. 84.
    Desta Z et al (2002) Clinical significance of the cytochrome P450 2C19 genetic polymorphism. Clin Pharmacokinet 41(12):913–958PubMedCrossRefGoogle Scholar
  85. 85.
    Mega JL et al (2009) Cytochrome p-450 polymorphisms and response to clopidogrel. N Engl J Med 360(4):354–362PubMedCrossRefGoogle Scholar
  86. 86.
    Desai NR, Bhatt DL (2010) The state of periprocedural antiplatelet therapy after recent trials. JACC Cardiovasc Interv 3(6):571–583PubMedCrossRefGoogle Scholar
  87. 87.
    Wallentin L et al (2010) Effect of CYP2C19 and ABCB1 single nucleotide polymorphisms on outcomes of treatment with ticagrelor versus clopidogrel for acute coronary syndromes: a genetic substudy of the PLATO trial. Lancet 376(9749):1320–1328PubMedCrossRefGoogle Scholar
  88. 88.
    O’Donoghue ML et al (2009) Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. Lancet 374(9694):989–997CrossRefGoogle Scholar
  89. 89.
    Bhatt DL et al (2010) Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med 363(20):1909–1917PubMedCrossRefGoogle Scholar
  90. 90.
    Catella-Lawson F et al (2001) Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med 345(25):1809–1817PubMedCrossRefGoogle Scholar
  91. 91.
    Onuma Y et al (2010) Three-year results of clinical follow-up after a bioresorbable everolimus-eluting scaffold in patients with de novo coronary artery disease: the ABSORB trial. EuroIntervention 6(4):447–453PubMedCrossRefGoogle Scholar

Copyright information

© Urban &amp; Vogel, Muenchen 2011

Authors and Affiliations

  1. 1.CardiologyUniversity FribourgFribourgSchweiz

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