This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: August 14, 2007, Volume 116, Number 7 All Versions of this Article: 116/7/745    most recent CIRCULATIONAHA.106.686048v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Airoldi, F. Articles by Grube, E. Search for Related Content PubMed PubMed Citation Articles by Airoldi, F. Articles by Grube, E. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID TAXOL Related Collections Catheter-based coronary interventions: stents

(Circulation. 2007;116:745-754.)
© 2007 American Heart Association, Inc.

Interventional Cardiology

Incidence and Predictors of Drug-Eluting Stent Thrombosis During and After Discontinuation of Thienopyridine Treatment

Flavio Airoldi, MD^*; Antonio Colombo, MD^*; Nuccia Morici, MD; Azeem Latib, MD; John Cosgrave, MD; Lutz Buellesfeld, MD; Erminio Bonizzoni, MD; Mauro Carlino, MD; Ulrich Gerckens, MD; Cosmo Godino, MD; Gloria Melzi, MD; Iassen Michev, MD; Matteo Montorfano, MD; Giuseppe Massimo Sangiorgi, MD; Asif Qasim, MD; Alaide Chieffo, MD; Carlo Briguori, MD, PhD; Eberhard Grube, MD

From Invasive Cardiology Unit (F.A., A. Colombo, N.M., A.L., M.C., C.G., G.M., I.M., M.M., G.M.S., A. Chieffo), San Raffaele Scientific Institute, Milan, Italy; Emo Centro Cuore Columbus (A. Colombo, J.C., G.M.S., A.Q.), Milan, Italy; Department of Cardiology and Angiology, Helios Heart Center Siegburg (L.B., U.G., E.G.), Siegburg, Germany; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Laboratory of Interventional Cardiology Clinica Mediterranea (C.B.), Naples, Italy.

Correspondence to Antonio Colombo, MD, EMO Centro Cuore Columbus Hospital, Via Buonarroti, 48-20145, Milan, Italy. E-mail info{at}emocolumbus.it

Received December 21, 2006; accepted May 25, 2007.

Background— The need for prolonged aspirin and thienopyridine therapy and the risk of stent thrombosis (ST) remain as drawbacks associated with drug-eluting stents.

Methods and Results— A prospective observational cohort study was conducted between June 2002 and January 2004 on 3021 patients consecutively and successfully treated in 5389 lesions with drug-eluting stents. Detailed patient information was collected on antiplatelet therapy. We analyzed the incidence of ST throughout the 18-month follow-up period and its relationship with thienopyridine therapy. ST occurred in 58 patients (1.9%) at 18 months. Forty-two patients (1.4%) experienced the event within 6 months of stent implantation. Acute myocardial infarction (fatal or nonfatal) occurred in 46 patients (79%) and death in 23 patients (39%) with ST. The median interval from discontinuation of thienopyridine therapy to ST was 13.5 days (interquartile range 5.2 to 25.7 days) for the first 6 months and 90 days (interquartile range 30 to 365 days) between 6 and 18 months. On multivariable analysis, the strongest predictor for ST within 6 months of stenting was discontinuation of thienopyridine therapy (hazard ratio, 13.74; 95% CI, 4.04 to 46.68; P<0.001). Thienopyridine discontinuation after 6 months did not predict the occurrence of ST (hazard ratio, 0.94; 95% CI, 0.30 to 2.98; P=0.92).

Conclusions— Discontinuation of thienopyridine therapy was the major determinant of ST within the first 6 months, but insufficient information is available to determine whether there is benefit in continuing a thienopyridine beyond 6 months.

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