(Circulation. 2001;103:1967.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Stent Thrombosis in the Modern Era
A Pooled Analysis of Multicenter Coronary Stent Clinical Trials
From the University of Rochester Medical Center, Rochester, NY (D.E.C.); Beth Israel Deaconess Medical Center, Boston, Mass (D.E.C., K.K.L.H., D.J.C., J.P.C., M.S.C., O.R.); Brigham and Women’s Hospital, Boston, Mass (D.S.B., J.J.P., R.E.K.); and Cardiology Research Foundation, Lenox-Hill Hospital, New York, NY (A.J.L.).
Background—There are limited studies of stent thrombosis in the modern era of second-generation stents, high-pressure deployment, and current antithrombotic regimens.
Methods and Results—Six
recently completed coronary stent trials and associated nonrandomized
registries that enrolled 6186 patients (6219 treated vessels) treated
with 
1 coronary stent followed by antiplatelet therapy with aspirin
and ticlopidine were pooled for this analysis. Within 30 days, clinical
stent thrombosis developed in 53 patients (0.9%). The variables most
significantly associated with the probability of stent thrombosis were
persistent dissection NHLBI grade B or higher after stenting (OR, 3.7;
95% CI, 1.9 to 7.7), total stent length (OR, 1.3; 95% CI, 1.2 to 1.5
per 10 mm), and final minimal lumen diameter within the stent (OR, 0.4;
95% CI, 0.2 to 0.7 per 1 mm). Stent thrombosis was documented by
angiography in 45 patients (0.7%). Clinical consequences of
angiographic stent thrombosis included 64.4% incidence of death or
myocardial infarction at the time of stent thrombosis and 8.9% 6-month
mortality.
Conclusions—Stent thrombosis occurred in <1.0% of patients undergoing stenting of native coronary artery lesions and receiving routine antiplatelet therapy with aspirin plus ticlopidine. Procedure-related variables of persistent dissection, total stent length, and final lumen diameter were significantly associated with the probability of stent thrombosis. Continued efforts to eliminate this complication are warranted given the serious clinical consequences.
Key Words: stents • thrombosis • myocardial infarction
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M. O'Donoghue and S. D. Wiviott Clopidogrel Response Variability and Future Therapies: Clopidogrel: Does One Size Fit All? Circulation, November 28, 2006; 114(22): e600 - e606. [Full Text] [PDF]
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A. Colombo and S. J. Corbett Drug-Eluting Stent Thrombosis: Increasingly Recognized But Too Frequently Overemphasized J. Am. Coll. Cardiol., July 4, 2006; 48(1): 203 - 205. [Full Text] [PDF]
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M. Joner, A. V. Finn, A. Farb, E. K. Mont, F. D. Kolodgie, E. Ladich, R. Kutys, K. Skorija, H. K. Gold, and R. Virmani Pathology of Drug-Eluting Stents in Humans: Delayed Healing and Late Thrombotic Risk J. Am. Coll. Cardiol., July 4, 2006; 48(1): 193 - 202. [Abstract] [Full Text] [PDF]
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J. A. Spertus, R. Kettelkamp, C. Vance, C. Decker, P. G. Jones, J. S. Rumsfeld, J. C. Messenger, S. Khanal, E. D. Peterson, R. G. Bach, et al. Prevalence, Predictors, and Outcomes of Premature Discontinuation of Thienopyridine Therapy After Drug-Eluting Stent Placement: Results From the PREMIER Registry Circulation, June 20, 2006; 113(24): 2803 - 2809. [Abstract] [Full Text] [PDF]
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A. Hoye, I. Iakovou, L. Ge, C. A.G. van Mieghem, A. T.L. Ong, J. Cosgrave, G. M. Sangiorgi, F. Airoldi, M. Montorfano, I. Michev, et al. Long-Term Outcomes After Stenting of Bifurcation Lesions With the "Crush" Technique: Predictors of an Adverse Outcome J. Am. Coll. Cardiol., May 16, 2006; 47(10): 1949 - 1958. [Abstract] [Full Text] [PDF]
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C. Rogers and E. R. Edelman Pushing Drug-Eluting Stents Into Uncharted Territory: Simpler Than You Think--More Complex Than You Imagine Circulation, May 16, 2006; 113(19): 2262 - 2265. [Full Text] [PDF]
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T. Jernberg, C. D. Payne, K. J. Winters, C. Darstein, J. T. Brandt, J. A. Jakubowski, H. Naganuma, A. Siegbahn, and L. Wallentin Prasugrel achieves greater inhibition of platelet aggregation and a lower rate of non-responders compared with clopidogrel in aspirin-treated patients with stable coronary artery disease Eur. Heart J., May 2, 2006; 27(10): 1166 - 1173. [Abstract] [Full Text] [PDF]
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P. Urban, A. H. Gershlick, G. Guagliumi, P. Guyon, C. Lotan, J. Schofer, A. Seth, J. E. Sousa, W. Wijns, C. Berge, et al. Safety of Coronary Sirolimus-Eluting Stents in Daily Clinical Practice: One-Year Follow-Up of the e-Cypher Registry Circulation, March 21, 2006; 113(11): 1434 - 1441. [Abstract] [Full Text] [PDF]
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G. G.L. Biondi-Zoccai, P. Agostoni, G. M. Sangiorgi, F. Airoldi, J. Cosgrave, A. Chieffo, R. Barbagallo, C. Tamburino, G. Vittori, E. Falchetti, et al. Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation Eur. Heart J., March 1, 2006; 27(5): 540 - 546. [Abstract] [Full Text] [PDF]
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P. K. Kuchulakanti, W. W. Chu, R. Torguson, P. Ohlmann, S.-W. Rha, L. C. Clavijo, S.-W. Kim, A. Bui, N. Gevorkian, Z. Xue, et al. Correlates and Long-Term Outcomes of Angiographically Proven Stent Thrombosis With Sirolimus- and Paclitaxel-Eluting Stents Circulation, February 28, 2006; 113(8): 1108 - 1113. [Abstract] [Full Text] [PDF]
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R. Moreno, C. Fernandez, and C. Macaya Drug-eluting stent thrombosis: Results from a pooled analysis including 10 randomized studies: Reply J. Am. Coll. Cardiol., January 3, 2006; 47(1): 214 - 215. [Full Text] [PDF]
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R. Moreno, C. Fernandez, and C. Macaya Drug-eluting stent thrombosis: Results from a pooled analysis including 10 randomized studies.REPLY J. Am. Coll. Cardiol., December 13, 2005; (2005) j.jacc.2005.10.015v1. [Full Text] [PDF]
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P. A. Gurbel, K. P. Bliden, W. Samara, J. A. Yoho, K. Hayes, M. Z. Fissha, and U. S. Tantry Clopidogrel Effect on Platelet REactivity in Patients With Stent Thrombosis: Results of the CREST Study J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1827 - 1832. [Abstract] [Full Text] [PDF]
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D. E. Cutlip and R. E. Kuntz Cardiac Enzyme Elevation After Successful Percutaneous Coronary Intervention Is Not an Independent Predictor of Adverse Outcomes Circulation, August 9, 2005; 112(6): 916 - 923. [Full Text] [PDF]
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H.-J. Priebe Perioperative myocardial infarction--aetiology and prevention Br. J. Anaesth., July 1, 2005; 95(1): 3 - 19. [Abstract] [Full Text] [PDF]
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P. Wenaweser, J. Dorffler-Melly, K. Imboden, S. Windecker, M. Togni, B. Meier, A. Haeberli, and O. M. Hess Stent Thrombosis Is Associated With an Impaired Response to Antiplatelet Therapy J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1748 - 1752. [Abstract] [Full Text] [PDF]
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