(Circulation. 2001;103:1967.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
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 Womens 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.).
| Abstract |
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Methods and ResultsSix
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.
ConclusionsStent 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
| Introduction |
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3.5%, although this was achieved at the cost of aggressive
anticoagulation with an associated high rate of bleeding
complications.1 2
More recently, studies using either routine high-pressure postdilation
stenting or intravascular ultrasound guidance and antiplatelet
therapy with aspirin and ticlopidine have reported reduced rates of
stent thrombosis of 0.5% to 1.9% without an associated increased
bleeding
risk.8 9 10 11 12 13 14 15 Detailed analyses of stent thrombosis from studies using exclusive modern stenting techniques and antiplatelet therapy have been limited,12 13 and no data are available regarding the second-generation stents that now account for essentially all coronary stent procedures. The purpose of this study was to analyze the frequency, timing, clinical outcomes, and predictors of stent thrombosis in a pooled population of 6186 patients who received stents as part of 6 recently completed randomized trials and associated nonrandomized registries.
| Methods |
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Study Patients and Stenting Protocol
All patients treated within the 6 clinical trials who
received
1 coronary stent and who were treated with aspirin and
ticlopidine after the stent procedure were eligible for this analysis.
The protocol for each study included routine high-pressure (
12 atm)
postdilation. Aspirin 325 mg daily and ticlopidine 250 mg twice
daily for 4 weeks was the standard postprocedure antithrombotic
regimen. Use of glycoprotein IIb/IIIa inhibitors was discouraged in all
of the studies; they were used at the discretion of the investigator in
7.6% of patients overall.
Clinical End Points and Definitions
Clinical stent thrombosis was defined as any of the
following within 30 days of the procedure: angiographic documentation
of stent occlusion, unexplained sudden death when the stent was not
known to be patent, myocardial infarction, or urgent target lesion
revascularization within 30 days of the procedure. Angiographic stent
thrombosis required angiographic documentation of stent occlusion.
Clinical end points included all-cause mortality and recurrent
myocardial infarction. Myocardial infarction was defined as Q-wave
myocardial infarction (development of new regional pathological Q waves
as determined by the ECG core laboratory) or nonQ-wave myocardial
infarction (defined as total creatine kinase >2 times or creatine
kinase-MB >3 times the upper limit of normal). Coronary luminal
dimensions were calculated as previously
described.16 The Clinical
End Points Committee adjudicated all events. Coronary dissections
before and after stent placement were defined as types A through F with
the NHLBI classification.
Statistical Analysis
Continuous variables were examined with Students
t tests. Binary and
polychotomous variables were examined with Fishers exact and
2 tests. Survival estimates were computed
by use of Kaplan-Meier methods and compared through log-rank tests.
Predictors of clinical stent thrombosis were analyzed with
multivariable logistic regression
models.17 All statistical
analyses were performed with SAS for Windows (version 6.12, SAS
Institute).
| Results |
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Manifestations and Clinical Outcomes of
Stent Thrombosis
Of the 53 clinical stent thrombosis events, 45 were
confirmed by angiography. Most stent thrombosis events occurred
within the first 2 days of the procedure (the
Figure
).
Stent thrombosis events occurring >1 week after the stent procedure
were rare, with only 2 of 53 clinical stent thrombosis events after day
8 and no angiographically documented stent thromboses after day
5.
|
Clinical outcomes at 30 days and 6 months are shown in
Table 5
. The 6-month mortality for either definition of
stent thrombosis was significantly higher than the 1.2% observed in
the overall pooled population.
|
Multivariable Modeling and Predictors of
Stent Thrombosis
Observed frequencies of clinical stent thrombosis
and results of logistic regression models are shown in
Table 6
. Of note, unstable angina presentation (OR, 1.1;
95% CI, 0.6 to 1.9), discretionary use of glycoprotein IIb/IIIa
inhibitors (OR, 1.4; 95% CI, 0.6 to 3.3), nonrandomized versus
randomized status (OR, 1.6; 95% CI, 0.7 to 3.8), and specific stent
type were not significantly associated with the probability of clinical
stent thrombosis. Stenting for threatened or abrupt closure was a
significant univariate predictor but was no longer significant after
adjustment for stent length, final lumen diameter, and the presence of
residual dissection. Only 2 (0.2%) of the 1281 vessels meeting
criteria for an "optimal" stent developed stent
thrombosis.
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| Discussion |
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In addition to a marked reduction in the incidence of stent thrombosis, our results also show a significant impact on the timing of stent thrombosis compared with older studies using aggressive anticoagulation protocols. The median time to occurrence was 1 day with virtual elimination of events after day 2 compared with a median time to occurrence of 4 to 5 days and frequent events 2 to 3 weeks after stent implantation reported in earlier series.1 19 20 21 22 The observed lesser efficacy of ticlopidine in the first 2 days may reflect imperfect results that were "doomed to thrombose." The other explanation, however, which would be consistent with the known pharmacokinetics of ticlopidine, is that the lack of protection in this early period is due largely to its delayed onset of action.
Clinical consequences of stent thrombosis in the present series were dire. Angiographically documented stent thrombosis was associated with a mortality rate of 6.7% at 30 days and 8.9% at 6 months compared with a mortality rate of 1.0% at 6 months in patients who did not experience stent thrombosis. For clinically defined stent thrombosis events, the associated 6-month mortality was 20.8%. These findings are consistent with the disastrous consequences of stent thrombosis reported in early studies1 6 19 21 23 24 and are somewhat surprising because stent thrombosis events in our study patients were much more likely to occur while patients were still hospitalized. This is consistent, however, with a report by Hasdai et al25 that showed poor clinical outcomes despite prompt restoration of blood flow after stent thrombosis. The recent registry reports by Moussa et al13 and Karrillon et al12 with ticlopidine therapy and modern stent implantation techniques also reported high 30-day mortality rates of 26% and 24%, respectively.
The most significant predictors of stent thrombosis included persistent dissection NHLBI grade B or higher after stenting, longer stent length, and final minimal lumen diameter within the stent. Multiple stents and longer stents should be used then only when needed to cover significant extrastent stenosis or dissection rather than for convenience or purely cosmetic indications. The importance of obtaining a large postprocedural lumen in the prevention of acute thrombosis is also underscored.26
Interestingly, stenting for threatened or abrupt closure and the presence of significant prestent dissections were not independent predictors of stent thrombosis in this series. This is contrary to several other studies.12 24 27 It should be noted, however, that earlier experience with stenting for abrupt or threatened closure may have included a higher frequency of true "bailout" indications than in the present series. The absence of unstable angina as a risk factor is also somewhat surprising and may reflect the exclusion of patients with suspected acute myocardial infarction or angiographic evidence of thrombus from the clinical trials that were pooled for this analysis or represent an extension of the protective benefits of aspirin and ticlopidine to this subgroup of patients. Finally, low ejection fraction, which has been reported to be a risk factor in other studies,13 may not have been significant in our study largely because patients with markedly reduced ejection fraction were excluded from the trials included in this analysis. The low risk of stent thrombosis for patients with "optimal" stenting in our study may have implications for future outpatient stenting protocols.
Study Limitations
This pooled analysis has several limitations.
First, because the data are pooled from several clinical trials, this
analysis does not have the power of a single randomized trial using a
random assignment of antithrombotic regimens and stent design. Second,
the analysis is unavoidably limited to the antithrombotic regimens then
in effect. The effect of pretreatment or shorter poststent courses of
ticlopidine or newer oral antiplatelet agents such as clopidogrel
cannot be determined. Likewise, the use of platelet IIb/IIIa inhibitors
was too infrequent to determine the effect on the frequency of stent
thrombosis. On the basis of the proven benefits of these agents to
reduce acute ischemic complications after
stenting,28 such adjunctive
treatment would seem reasonable, especially in patients having
1 of
the risk factors for stent thrombosis identified in this study. Third,
it cannot be excluded that clinical events adjudicated as clinical
stent thrombosis were in fact due to other causes. Similarly, in the
absence of complete 30-day angiographic follow-up, cases of silent
stent thrombosis cannot be excluded. Finally, the conclusions drawn
from the selected clinical trials may not be generalizable to the
broader populations treated in daily practice. More specifically,
conclusions from the multivariable model are limited to statistical
associations within this sample. Causal assertions should not be made
before the model is validated in a test
sample.
| Footnotes |
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Received November 14, 2000; revision received January 10, 2001; accepted January 19, 2001.
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L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Circulation, October 23, 2007; 116(17): e418 - e500. [Full Text] [PDF] |
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J. W. Riddell, L. Chiche, B. Plaud, and M. Hamon Coronary Stents and Noncardiac Surgery Circulation, October 16, 2007; 116(16): e378 - e382. [Full Text] [PDF] |
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D. Charytan, J. P. Forman, and D. E. Cutlip Risk of target lesion revascularization after coronary stenting in patients with and without chronic kidney disease Nephrol. Dial. Transplant., September 1, 2007; 22(9): 2578 - 2585. [Abstract] [Full Text] [PDF] |
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J. Daemen and P. W. Serruys Drug-Eluting Stent Update 2007: Part II: Unsettled Issues Circulation, August 21, 2007; 116(8): 961 - 968. [Full Text] [PDF] |
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G. Sianos, M. I. Papafaklis, J. Daemen, S. Vaina, C. A. van Mieghem, R. T. van Domburg, L. K. Michalis, and P. W. Serruys Angiographic Stent Thrombosis After Routine Use of Drug-Eluting Stents in ST-Segment Elevation Myocardial Infarction: The Importance of Thrombus Burden J. Am. Coll. Cardiol., August 14, 2007; 50(7): 573 - 583. [Abstract] [Full Text] [PDF] |
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A. A. Bavry and D. L. Bhatt Drug-Eluting Stents: Dual Antiplatelet Therapy for Every Survivor? Circulation, August 14, 2007; 116(7): 696 - 699. [Full Text] [PDF] |
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F. Airoldi, A. Colombo, N. Morici, A. Latib, J. Cosgrave, L. Buellesfeld, E. Bonizzoni, M. Carlino, U. Gerckens, C. Godino, et al. Incidence and Predictors of Drug-Eluting Stent Thrombosis During and After Discontinuation of Thienopyridine Treatment Circulation, August 14, 2007; 116(7): 745 - 754. [Abstract] [Full Text] [PDF] |
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M. Moscucci Behavioral Factors, Bias, and Practice Guidelines in the Decision to Use Percutaneous Coronary Interventions for Stable Coronary Artery Disease Arch Intern Med, August 13, 2007; 167(15): 1573 - 1575. [Full Text] [PDF] |
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R. Jaffe and B. H. Strauss Late and Very Late Thrombosis of Drug-Eluting Stents: Evolving Concepts and Perspectives J. Am. Coll. Cardiol., July 10, 2007; 50(2): 119 - 127. [Abstract] [Full Text] [PDF] |
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D. R. Holmes Jr, D. J. Kereiakes, W. K. Laskey, A. Colombo, S. G. Ellis, T. D. Henry, J. J. Popma, P. W.J.C. Serruys, T. Kimura, D. O. Williams, et al. Thrombosis and Drug-Eluting Stents: An Objective Appraisal J. Am. Coll. Cardiol., July 10, 2007; 50(2): 109 - 118. [Abstract] [Full Text] [PDF] |
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E. S. Brilakis, S. Banerjee, and P. B. Berger Perioperative Management of Patients With Coronary Stents J. Am. Coll. Cardiol., June 5, 2007; 49(22): 2145 - 2150. [Abstract] [Full Text] [PDF] |
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C. L. Grines, R. O. Bonow, D. E. Casey Jr, T. J. Gardner, P. B. Lockhart, D. J. Moliterno, P. O'Gara, and P. Whitlow Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: A science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians J Am Dent Assoc, May 1, 2007; 138(5): 652 - 655. [Abstract] [Full Text] [PDF] |
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G. M. Howard-Alpe, J. de Bono, L. Hudsmith, W. P. Orr, P. Foex, and J. W. Sear Coronary artery stents and non-cardiac surgery Br. J. Anaesth., May 1, 2007; 98(5): 560 - 574. [Abstract] [Full Text] [PDF] |
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D. E. Cutlip, S. Windecker, R. Mehran, A. Boam, D. J. Cohen, G.-A. van Es, P. Gabriel Steg, M.-a. Morel, L. Mauri, P. Vranckx, et al. Clinical End Points in Coronary Stent Trials: A Case for Standardized Definitions Circulation, May 1, 2007; 115(17): 2344 - 2351. [Abstract] [Full Text] [PDF] |
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B. J.G.L. de Smet and F. Zijlstra A look at drug eluting stents with optical coherence tomography Eur. Heart J., April 2, 2007; 28(8): 918 - 919. [Full Text] [PDF] |
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L. Mauri, W.-h. Hsieh, J. M. Massaro, K. K.L. Ho, R. D'Agostino, and D. E. Cutlip Stent Thrombosis in Randomized Clinical Trials of Drug-Eluting Stents N. Engl. J. Med., March 8, 2007; 356(10): 1020 - 1029. [Abstract] [Full Text] [PDF] |
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T. F. Luscher, J. Steffel, F. R. Eberli, M. Joner, G. Nakazawa, F. C. Tanner, and R. Virmani Drug-Eluting Stent and Coronary Thrombosis: Biological Mechanisms and Clinical Implications Circulation, February 27, 2007; 115(8): 1051 - 1058. [Abstract] [Full Text] [PDF] |
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C. L. Grines, R. O. Bonow, D. E. Casey Jr, T. J. Gardner, P. B. Lockhart, D. J. Moliterno, P. O'Gara, and P. Whitlow Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, With Representation From the American College of Physicians J. Am. Coll. Cardiol., February 13, 2007; 49(6): 734 - 739. [Abstract] [Full Text] [PDF] |
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C. L. Grines, R. O. Bonow, D. E. Casey Jr, T. J. Gardner, P. B. Lockhart, D. J. Moliterno, P. O'Gara, and P. Whitlow Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, With Representation From the American College of Physicians Circulation, February 13, 2007; 115(6): 813 - 818. [Abstract] [Full Text] [PDF] |
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E. L. Eisenstein, K. J. Anstrom, D. F. Kong, L. K. Shaw, R. H. Tuttle, D. B. Mark, J. M. Kramer, R. A. Harrington, D. B. Matchar, D. E. Kandzari, et al. Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation JAMA, January 10, 2007; 297(2): 159 - 168. [Abstract] [Full Text] [PDF] |
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O. F. Bertrand, R. De Larochelliere, J. Rodes-Cabau, G. Proulx, O. Gleeton, C. Manh Nguyen, J.-P. Dery, G. Barbeau, B. Noel, E. Larose, et al. A Randomized Study Comparing Same-Day Home Discharge and Abciximab Bolus Only to Overnight Hospitalization and Abciximab Bolus and Infusion After Transradial Coronary Stent Implantation Circulation, December 12, 2006; 114(24): 2636 - 2643. [Abstract] [Full Text] [PDF] |
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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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G. W. Stone and H. D. Aronow Long-term Care After Percutaneous Coronary Intervention: Focus on the Role of Antiplatelet Therapy Mayo Clin. Proc., May 1, 2006; 81(5): 641 - 652. [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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S H Hofma, A T L Ong, J Aoki, C A G van Mieghem, G A Rodriguez Granillo, M Valgimigli, E Regar, P P T de Jaegere, E P McFadden, G Sianos, et al. One year clinical follow up of paclitaxel eluting stents for acute myocardial infarction compared with sirolimus eluting stents Heart, September 1, 2005; 91(9): 1176 - 1180. [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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N. Ajzenberg, P. Aubry, M.-G. Huisse, A. Cachier, W. El Amara, L. J. Feldman, D. Himbert, D. Baruch, M.-C. Guillin, and Ph. G. Steg Enhanced Shear-Induced Platelet Aggregation in Patients Who Experience Subacute Stent Thrombosis: A Case-Control Study J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1753 - 1756. [Abstract] [Full Text] [PDF] |
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A. Jeremias, D. S. Baim, R. E. Kuntz, and D. E. Cutlip Reply J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1908 - 1909. [Full Text] [PDF] |
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P. Wenaweser, C. Rey, F. R. Eberli, M. Togni, D. Tuller, S. Locher, A. Remondino, C. Seiler, O. M. Hess, B. Meier, et al. Stent thrombosis following bare-metal stent implantation: success of emergency percutaneous coronary intervention and predictors of adverse outcome Eur. Heart J., June 2, 2005; 26(12): 1180 - 1187. [Abstract] [Full Text] [PDF] |
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E Karvouni, S Korovesis, and D G Katritsis Very late thrombosis after implantation of sirolimus eluting stent Heart, June 1, 2005; 91(6): e45 - e45. [Abstract] [Full Text] [PDF] |
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L. Ge, I. Iakovou, J. Cosgrave, A. Chieffo, M. Montorfano, I. Michev, F. Airoldi, M. Carlino, G. Melzi, G. M. Sangiorgi, et al. Immediate and mid-term outcomes of sirolimus-eluting stent implantation for chronic total occlusions Eur. Heart J., June 1, 2005; 26(11): 1056 - 1062. [Abstract] [Full Text] [PDF] |
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I. Iakovou, T. Schmidt, E. Bonizzoni, L. Ge, G. M. Sangiorgi, G. Stankovic, F. Airoldi, A. Chieffo, M. Montorfano, M. Carlino, et al. Incidence, Predictors, and Outcome of Thrombosis After Successful Implantation of Drug-Eluting Stents JAMA, May 4, 2005; 293(17): 2126 - 2130. [Abstract] [Full Text] [PDF] |
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P. A. Gurbel, K. P. Bliden, K. M. Hayes, J. A. Yoho, W. R. Herzog, and U. S. Tantry The Relation of Dosing to Clopidogrel Responsiveness and the Incidence of High Post-Treatment Platelet Aggregation in Patients Undergoing Coronary Stenting J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1392 - 1396. [Abstract] [Full Text] [PDF] |
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L. Ge, I. Iakovou, G. M. Sangiorgi, A. Chieffo, G. Melzi, J. Cosgrave, M. Montorfano, I. Michev, F. Airoldi, M. Carlino, et al. Treatment of saphenous vein graft lesions with drug-eluting stents: Immediate and midterm outcome J. Am. Coll. Cardiol., April 5, 2005; 45(7): 989 - 994. [Abstract] [Full Text] [PDF] |
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K. Fujii, S. G. Carlier, G. S. Mintz, Y.-m. Yang, I. Moussa, G. Weisz, G. Dangas, R. Mehran, A. J. Lansky, E. M. Kreps, et al. Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: An intravascular ultrasound study J. Am. Coll. Cardiol., April 5, 2005; 45(7): 995 - 998. [Abstract] [Full Text] [PDF] |
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A. A. Bavry, D. J. Kumbhani, T. J. Helton, and D. L. Bhatt What is the risk of stent thrombosis associated with the use of paclitaxel-eluting stents for percutaneous coronary intervention?: A meta-analysis J. Am. Coll. Cardiol., March 15, 2005; 45(6): 941 - 946. [Abstract] [Full Text] [PDF] |
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A. T.L. Ong, A. Hoye, J. Aoki, C. A.G. van Mieghem, G. A. Rodriguez Granillo, K. Sonnenschein, E. Regar, E. P. McFadden, G. Sianos, W. J. van der Giessen, et al. Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation J. Am. Coll. Cardiol., March 15, 2005; 45(6): 947 - 953. [Abstract] [Full Text] [PDF] |
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R. Moreno, C. Fernandez, R. Hernandez, F. Alfonso, D. J. Angiolillo, M. Sabate, J. Escaned, C. Banuelos, A. Fernandez-Ortiz, and C. Macaya Drug-eluting stent thrombosis: Results from a pooled analysis including 10 randomized studies J. Am. Coll. Cardiol., March 15, 2005; 45(6): 954 - 959. [Abstract] [Full Text] [PDF] |
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