BACKGROUND: Stent thrombosis (ST) is a rare, but extremely severe complication of PCI. Outside clinical trials, data are limited regarding the risks and the impact of this phenomenon. AIMS: To assess prevalence, predictors, and clinical outcome of ST after implantation of drug eluting stents (DES) compared with bare metal stents (BMS), in a large case-control study in a real world scenario, as well as the relation between ST and duration of combined antiplatelet treatment. METHODS: In a case-control registry we included 475 patients who received at least 1 DES (sirolimus, zotarolimus, everolimus, paclitaxel), compared with a group of 475 patients who received at least 1 BMS. We used 1.22 DES/patient vs. 1.26 BMS/patient (p=ns), treating 1.02 DES/lesion vs. 1.05 BMS/lesion (p=ns). Main outcome was ST defined by the Academic Research Consortium (ARC) as definite (acute, sub-acute, late), probable, and possible. RESULTS: At 15 months we found 0.8% (4) patients in the DES group vs. 1.1% (5) patients in the BMS group with definite ST (ns); 0.4% (2) patients from each group had acute ST, while 0.4% (2) vs. 0.7% (3) patients had sub-acute ST (both comparisons were ns). None of the patients from the DES group died, whereas two patients with definite ST from the BMS group died, with a case fatality rate of 40% (2/5). 0.2% (1) patient from each group had probable ST (ns) and 0.6% (3) vs. 0.4% (2) patients had possible ST (ns). Independent predictors of stent thrombosis in merged groups were antiplatelet therapy discontinuation (HR 3.8; 95%CI 1.9-7.6; p<0.01), diabetes (HR 2.15; 95%CI 1.4-5.1; p<0.01), a lower left ventricular ejection fraction (EF) (HR 1.1; 95%CI 1.0-1.9; p<0.01 for each 10% decrease), and LAD lesions (HR 1.0; 95%CI, 0.93-1.9; P<0.01). CONCLUSIONS: ST is a rare complication (0.95%), similar after DES or BMS implantation. Premature discontinuation of antiplatelet therapy, followed by diabetes and a lower LVEF, are the independent predictors of ST.
BACKGROUND: Stent thrombosis (ST) is a rare, but extremely severe complication of PCI. Outside clinical trials, data are limited regarding the risks and the impact of this phenomenon. AIMS: To assess prevalence, predictors, and clinical outcome of ST after implantation of drug eluting stents (DES) compared with bare metal stents (BMS), in a large case-control study in a real world scenario, as well as the relation between ST and duration of combined antiplatelet treatment. METHODS: In a case-control registry we included 475 patients who received at least 1 DES (sirolimus, zotarolimus, everolimus, paclitaxel), compared with a group of 475 patients who received at least 1 BMS. We used 1.22 DES/patient vs. 1.26 BMS/patient (p=ns), treating 1.02 DES/lesion vs. 1.05 BMS/lesion (p=ns). Main outcome was ST defined by the Academic Research Consortium (ARC) as definite (acute, sub-acute, late), probable, and possible. RESULTS: At 15 months we found 0.8% (4) patients in the DES group vs. 1.1% (5) patients in the BMS group with definite ST (ns); 0.4% (2) patients from each group had acute ST, while 0.4% (2) vs. 0.7% (3) patients had sub-acute ST (both comparisons were ns). None of the patients from the DES group died, whereas two patients with definite ST from the BMS group died, with a case fatality rate of 40% (2/5). 0.2% (1) patient from each group had probable ST (ns) and 0.6% (3) vs. 0.4% (2) patients had possible ST (ns). Independent predictors of stent thrombosis in merged groups were antiplatelet therapy discontinuation (HR 3.8; 95%CI 1.9-7.6; p<0.01), diabetes (HR 2.15; 95%CI 1.4-5.1; p<0.01), a lower left ventricular ejection fraction (EF) (HR 1.1; 95%CI 1.0-1.9; p<0.01 for each 10% decrease), and LAD lesions (HR 1.0; 95%CI, 0.93-1.9; P<0.01). CONCLUSIONS: ST is a rare complication (0.95%), similar after DES or BMS implantation. Premature discontinuation of antiplatelet therapy, followed by diabetes and a lower LVEF, are the independent predictors of ST.
Authors: E J Topol; J J Ferguson; H F Weisman; J E Tcheng; S G Ellis; N S Kleiman; R J Ivanhoe; A L Wang; D P Miller; K M Anderson; R M Califf Journal: JAMA Date: 1997-08-13 Impact factor: 56.272
Authors: Lei Ge; Flavio Airoldi; Ioannis Iakovou; John Cosgrave; Iassen Michev; Giuseppe M Sangiorgi; Matteo Montorfano; Alaide Chieffo; Mauro Carlino; Nicola Corvaja; Antonio Colombo Journal: J Am Coll Cardiol Date: 2005-08-16 Impact factor: 24.094
Authors: Jean-Pierre Bassand; Christian W Hamm; Diego Ardissino; Eric Boersma; Andrzej Budaj; Francisco Fernández-Avilés; Keith A A Fox; David Hasdai; E Magnus Ohman; Lars Wallentin; William Wijns Journal: Eur Heart J Date: 2007-06-14 Impact factor: 29.983
Authors: C M Gibson; S Murphy; I B Menown; R F Sequeira; R Greene; F Van de Werf; M J Schweiger; M Ghali; M J Frey; K A Ryan; S J Marble; R P Giugliano; E M Antman; C P Cannon; E Braunwald Journal: J Am Coll Cardiol Date: 1999-11-01 Impact factor: 24.094
Authors: Gregg W Stone; Stephen G Ellis; David A Cox; James Hermiller; Charles O'Shaughnessy; James Tift Mann; Mark Turco; Ronald Caputo; Patrick Bergin; Joel Greenberg; Jeffrey J Popma; Mary E Russell Journal: N Engl J Med Date: 2004-01-15 Impact factor: 91.245