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(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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