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 language | English |
|---|---|
| Pages (from-to) | 1108-1113 |
| Number of pages | 6 |
| Journal | Circulation |
| Volume | 113 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - 2006 Feb 1 |
| Externally published | Yes |
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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 journal › Article
}
TY - JOUR
T1 - Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents
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
UR - http://www.scopus.com/inward/record.url?scp=33645311266&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33645311266&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.105.600155
DO - 10.1161/CIRCULATIONAHA.105.600155
M3 - Article
C2 - 16490815
AN - SCOPUS:33645311266
VL - 113
SP - 1108
EP - 1113
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 8
ER -