Predictors of Coronary Stent Thrombosis

  • van Werkum J
  • Heestermans A
  • Zomer A
  • et al.
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Abstract

Objectives: This study sought to comprehensively identify predictors of stent thrombosis (ST). Background: Given the devastating consequences of ST, efforts should be directed toward risk stratification to identify patients at highest risk for ST. Methods: Consecutive patients with angiographic ST were enrolled. Patients who did not suffer from a ST were randomly selected in a 2:1 ratio and were matched for: 1) percutaneous coronary intervention (PCI) indication; 2) same date of index PCI; and 3) same interventional center. Results: Of 21,009 patients treated with either a bare-metal or drug-eluting stent, 437 patients (2.1%) presented with a definite ST. A total of 140 STs were acute, 180 were subacute, 58 were late, and 59 were very late. Undersizing of the coronary stent, Thrombolysis In Myocardial Infarction flow grade <3, present malignancy, presence of intermediate coronary artery disease proximal and distal to the culprit lesion, dissection, lack of aspirin, bifurcation lesions, ejection fraction <30%, and younger age were associated with ST. The lack of clopidogrel therapy at the time of ST in the first 30 days after the index PCI (hazard ratio [HR]: 36.5, 95% confidence interval [CI]: 8.0 to 167.8), between 30 days and 6 months after the index PCI (HR: 4.6, 95% CI: 1.4 to 15.3), and beyond 6 months (HR: 5.9, 95% CI: 1.7 to 19.8) after the index PCI was strongly associated with ST. Conclusions: Important correlates of ST were identified. Discontinuation of clopidogrel, undersizing of the coronary stent, present malignancy, and intermediate (???50% to <70% stenosis) coronary artery disease proximal to the culprit lesion were the strongest predictors of ST. ?? 2009 American College of Cardiology Foundation.

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APA

van Werkum, J. W., Heestermans, A. A., Zomer, A. C., Kelder, J. C., Suttorp, M.-J., Rensing, B. J., … ten Berg, J. M. (2009). Predictors of Coronary Stent Thrombosis. Journal of the American College of Cardiology, 53(16), 1399–1409. https://doi.org/10.1016/j.jacc.2008.12.055

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