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Standortbestimmung der Drug-Eluting-Stents ein Jahr nach Beginn der Sicherheitsdiskussion

Drug-eluting stents in coronary artery disease – One year after the safety discussion

  • Published:
Clinical Research in Cardiology Supplements Aims and scope

Zusammenfassung

DES sind auch im Langzeitverlauf äußerst effektiv in Bezug auf die Reinterventionsrate (TLR, TVR) im Vergleich zu den BMS. Dies ließ sich in der Nachbetrachtung der randomisiert kontrollierten Studien als Folge einer intensiv geführten Sicherheitsdiskussion eindrucksvoll bestätigen. DES sind auch sicher. Berücksichtigt werden muss aber, dass die DES-Implantation mit einem späten Stentthromboserisiko assoziiert ist. Dies gilt sowohl für den On-label- als auch für den Off-label-Einsatz und ist möglicherweise unabhängig von der Zeitdauer der dualen Thrombozytenfunktionshemmung. Bei klarer Indikationsstellung und korrekter interventioneller und pharmakologischer Begleittherapie überwiegen aber die Vorteile einer DES-Implantation in Bezug auf Wirksamkeit im Vergleich zu einem BMS. Somit können bei neutraler Sicherheit klinische Ereignisse mithilfe der DES durch die Prävention der In-Stent-Restenose reduziert werden.

Abstract

Long-term results from randomized trials, metaanalyses and observational registries have confirmed the effectiveness of DES in terms of TLR and TVR in up to 5 years of follow-up. Moreover, the safety of DES is comparable to that of BMS. The rate of stent thrombosis did not significantly differ compared to BMS. However, late stent thrombosis is still a vexing problem in patients with DES implantation. This holds true for on-label as well as for off-label use probably without influence of the length of dual platelet inhibition. Nevertheless, DES is beneficial in all lesion subsets in which DES has been tested. Clinical events resulting from stent thrombosis may be offset by a decrease in major cardiac adverse event rate associated with in-stent restenosis.

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Authors and Affiliations

  1. Klinik für klinische und molekulare Kardiologie, Franz-Volhard-Klinik, Universitätsmedizin Berlin (Gemeinsame Einrichtung der Freien Universität Berlin und der Humboldt-Universität zu Berlin) Campus Buch und HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    C. M. Gross, S. Schmidt & M. Bergmann

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  1. C. M. Gross
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  2. S. Schmidt
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  3. M. Bergmann
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Correspondence to C. M. Gross.

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Gross, C.M., Schmidt, S. & Bergmann, M. Standortbestimmung der Drug-Eluting-Stents ein Jahr nach Beginn der Sicherheitsdiskussion. Clin Res Cardiol Suppl 3, 85–89 (2008). https://doi.org/10.1007/s11789-008-0040-1

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