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Risk Model Predicts Preferred Stent Type

Incremental risk of very late stent thrombosis determines stent type

TUESDAY, May 6 (HealthDay News) -- A small increase in the yearly risk of very late stent thrombosis with drug-eluting stents would outweigh the restenosis benefit and make bare-metal stents the preferred option in patients undergoing percutaneous coronary intervention, researchers report in the May 13 issue of the Journal of the American College of Cardiology.

Pallav Garg, from Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues developed a decision analytic Markov model to compare the incremental risk of very late stent thrombosis in patients receiving drug-eluting stents versus bare-metal stents.

Assuming equal rates of stent thrombosis beyond one year, the investigators found that drug-eluting stents would lead to higher quality-adjusted life expectancy (16.262 versus 16.248 quality-adjusted life years). This benefit was reduced as the incremental risk difference increased. The threshold excess risk for very late drug-eluting stent thrombosis was 0.14 percent per year over four years of follow-up, above which bare-metal stents would be the preferred option, the researchers report.

"Larger clinical trials with longer follow-up are needed to estimate the risk of late stent thrombosis with greater certainty for existing and new drug-eluting stents," Garg and colleagues conclude.

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