Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents

Pramod K. Kuchulakanti, William W. Chu, Rebecca Torguson, Patrick Ohlmann, Seung-Woon Rha, Leonardo C. Clavijo, Sang Wook Kim, Ahn Bui, Natalie Gevorkian, Zhenyi Xue, Kimberly Smith, Jana Fournadjieva, William O. Suddath, Lowell F. Satler, Augusto D. Pichard, Kenneth M. Kent, Ron Waksman

Research output: Contribution to journalArticle

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Abstract

Background - Stent thrombosis (ST) is a serious complication of drug-eluting stent (DES) implantation regardless of the timing (acute, subacute, or late). The correlates of ST with DES are not yet completely elucidated. Methods and Results - From a total cohort of 2974 consecutive patients treated with DES since April 2003, we identified 38 patients who presented with angiographic evidence of ST (1.27%). The ST occurred acutely in 5 patients, subacutely (s30 days) in 25 patients, and late (>30 days) in 8 patients. The clinical, angiographie, and procedural variables of these patients were compared with the remaining 2936 consecutive patients who underwent DES implantation and did not experience ST during a follow-up of 12 months. Logistic regression analysis was conducted to determine the correlates of ST. Compared with patients without ST, patients with ST had a higher frequency of diabetes, acute postprocedural renal failure, and chronic renal failure. There were more bifurcation lesions, type C lesions, and a trend for smaller-diameter stents. Discontinuation of clopidogrel was higher in these patients (36.8% versus 10.7%; P<0.0001). The mean duration to ST from the stent implantation was 8.9±8.5 days in subacute and 152.7±100.4 days in late thrombosis cases. Mortality was significantly higher in patients with ST compared with those without ST at 6 months (31% versus 3%; P<0.001). Multivariate analysis detected cessation of clopidogrel therapy, renal failure, bifurcation lesions, and in-stent restenosis as significant correlates of ST (P<0.05). Conclusions - ST continues to be a serious complication of contemporary DES use. Careful management is warranted in patients with renal failure and in those undergoing treatment for in-stent restenosis and bifurcations. Special focus on clopidogrel compliance may minimize the incidence of ST after DES implantation.

Original languageEnglish
Pages (from-to)1108-1113
Number of pages6
JournalCirculation
Volume113
Issue number8
DOIs
Publication statusPublished - 2006 Feb 1
Externally publishedYes

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Sirolimus
Paclitaxel
Stents
Thrombosis
Drug-Eluting Stents
clopidogrel
Renal Insufficiency
Acute Kidney Injury

Keywords

  • Angioplasty
  • Clopidogrel
  • Stents
  • Thrombosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents. / Kuchulakanti, Pramod K.; Chu, William W.; Torguson, Rebecca; Ohlmann, Patrick; Rha, Seung-Woon; Clavijo, Leonardo C.; Kim, Sang Wook; Bui, Ahn; Gevorkian, Natalie; Xue, Zhenyi; Smith, Kimberly; Fournadjieva, Jana; Suddath, William O.; Satler, Lowell F.; Pichard, Augusto D.; Kent, Kenneth M.; Waksman, Ron.

In: Circulation, Vol. 113, No. 8, 01.02.2006, p. 1108-1113.

Research output: Contribution to journalArticle

Kuchulakanti, PK, Chu, WW, Torguson, R, Ohlmann, P, Rha, S-W, Clavijo, LC, Kim, SW, Bui, A, Gevorkian, N, Xue, Z, Smith, K, Fournadjieva, J, Suddath, WO, Satler, LF, Pichard, AD, Kent, KM & Waksman, R 2006, 'Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents', Circulation, vol. 113, no. 8, pp. 1108-1113. https://doi.org/10.1161/CIRCULATIONAHA.105.600155
Kuchulakanti, Pramod K. ; Chu, William W. ; Torguson, Rebecca ; Ohlmann, Patrick ; Rha, Seung-Woon ; Clavijo, Leonardo C. ; Kim, Sang Wook ; Bui, Ahn ; Gevorkian, Natalie ; Xue, Zhenyi ; Smith, Kimberly ; Fournadjieva, Jana ; Suddath, William O. ; Satler, Lowell F. ; Pichard, Augusto D. ; Kent, Kenneth M. ; Waksman, Ron. / Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents. In: Circulation. 2006 ; Vol. 113, No. 8. pp. 1108-1113.
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abstract = "Background - Stent thrombosis (ST) is a serious complication of drug-eluting stent (DES) implantation regardless of the timing (acute, subacute, or late). The correlates of ST with DES are not yet completely elucidated. Methods and Results - From a total cohort of 2974 consecutive patients treated with DES since April 2003, we identified 38 patients who presented with angiographic evidence of ST (1.27{\%}). The ST occurred acutely in 5 patients, subacutely (s30 days) in 25 patients, and late (>30 days) in 8 patients. The clinical, angiographie, and procedural variables of these patients were compared with the remaining 2936 consecutive patients who underwent DES implantation and did not experience ST during a follow-up of 12 months. Logistic regression analysis was conducted to determine the correlates of ST. Compared with patients without ST, patients with ST had a higher frequency of diabetes, acute postprocedural renal failure, and chronic renal failure. There were more bifurcation lesions, type C lesions, and a trend for smaller-diameter stents. Discontinuation of clopidogrel was higher in these patients (36.8{\%} versus 10.7{\%}; P<0.0001). The mean duration to ST from the stent implantation was 8.9±8.5 days in subacute and 152.7±100.4 days in late thrombosis cases. Mortality was significantly higher in patients with ST compared with those without ST at 6 months (31{\%} versus 3{\%}; P<0.001). Multivariate analysis detected cessation of clopidogrel therapy, renal failure, bifurcation lesions, and in-stent restenosis as significant correlates of ST (P<0.05). Conclusions - ST continues to be a serious complication of contemporary DES use. Careful management is warranted in patients with renal failure and in those undergoing treatment for in-stent restenosis and bifurcations. Special focus on clopidogrel compliance may minimize the incidence of ST after DES implantation.",
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AU - Kuchulakanti, Pramod K.

AU - Chu, William W.

AU - Torguson, Rebecca

AU - Ohlmann, Patrick

AU - Rha, Seung-Woon

AU - Clavijo, Leonardo C.

AU - Kim, Sang Wook

AU - Bui, Ahn

AU - Gevorkian, Natalie

AU - Xue, Zhenyi

AU - Smith, Kimberly

AU - Fournadjieva, Jana

AU - Suddath, William O.

AU - Satler, Lowell F.

AU - Pichard, Augusto D.

AU - Kent, Kenneth M.

AU - Waksman, Ron

PY - 2006/2/1

Y1 - 2006/2/1

N2 - Background - Stent thrombosis (ST) is a serious complication of drug-eluting stent (DES) implantation regardless of the timing (acute, subacute, or late). The correlates of ST with DES are not yet completely elucidated. Methods and Results - From a total cohort of 2974 consecutive patients treated with DES since April 2003, we identified 38 patients who presented with angiographic evidence of ST (1.27%). The ST occurred acutely in 5 patients, subacutely (s30 days) in 25 patients, and late (>30 days) in 8 patients. The clinical, angiographie, and procedural variables of these patients were compared with the remaining 2936 consecutive patients who underwent DES implantation and did not experience ST during a follow-up of 12 months. Logistic regression analysis was conducted to determine the correlates of ST. Compared with patients without ST, patients with ST had a higher frequency of diabetes, acute postprocedural renal failure, and chronic renal failure. There were more bifurcation lesions, type C lesions, and a trend for smaller-diameter stents. Discontinuation of clopidogrel was higher in these patients (36.8% versus 10.7%; P<0.0001). The mean duration to ST from the stent implantation was 8.9±8.5 days in subacute and 152.7±100.4 days in late thrombosis cases. Mortality was significantly higher in patients with ST compared with those without ST at 6 months (31% versus 3%; P<0.001). Multivariate analysis detected cessation of clopidogrel therapy, renal failure, bifurcation lesions, and in-stent restenosis as significant correlates of ST (P<0.05). Conclusions - ST continues to be a serious complication of contemporary DES use. Careful management is warranted in patients with renal failure and in those undergoing treatment for in-stent restenosis and bifurcations. Special focus on clopidogrel compliance may minimize the incidence of ST after DES implantation.

AB - Background - Stent thrombosis (ST) is a serious complication of drug-eluting stent (DES) implantation regardless of the timing (acute, subacute, or late). The correlates of ST with DES are not yet completely elucidated. Methods and Results - From a total cohort of 2974 consecutive patients treated with DES since April 2003, we identified 38 patients who presented with angiographic evidence of ST (1.27%). The ST occurred acutely in 5 patients, subacutely (s30 days) in 25 patients, and late (>30 days) in 8 patients. The clinical, angiographie, and procedural variables of these patients were compared with the remaining 2936 consecutive patients who underwent DES implantation and did not experience ST during a follow-up of 12 months. Logistic regression analysis was conducted to determine the correlates of ST. Compared with patients without ST, patients with ST had a higher frequency of diabetes, acute postprocedural renal failure, and chronic renal failure. There were more bifurcation lesions, type C lesions, and a trend for smaller-diameter stents. Discontinuation of clopidogrel was higher in these patients (36.8% versus 10.7%; P<0.0001). The mean duration to ST from the stent implantation was 8.9±8.5 days in subacute and 152.7±100.4 days in late thrombosis cases. Mortality was significantly higher in patients with ST compared with those without ST at 6 months (31% versus 3%; P<0.001). Multivariate analysis detected cessation of clopidogrel therapy, renal failure, bifurcation lesions, and in-stent restenosis as significant correlates of ST (P<0.05). Conclusions - ST continues to be a serious complication of contemporary DES use. Careful management is warranted in patients with renal failure and in those undergoing treatment for in-stent restenosis and bifurcations. Special focus on clopidogrel compliance may minimize the incidence of ST after DES implantation.

KW - Angioplasty

KW - Clopidogrel

KW - Stents

KW - Thrombosis

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