title: Stent thrombosis following bare-metal stent implantation: success of emergency percutaneous coronary intervention and predictors of adverse outcome.
abstract: OBJECTIVE
  To investigate the efficacy and outcome of emergency percutaneous coronary interventions (PCI) in patients with stent thrombosis.
  
  
  RESULTS
  Between 1995 and 2003, 6058 patients underwent bare-metal stent implantation, of which 95 (1.6%) patients suffered from stent thrombosis. The timing of stent thrombosis was acute in 10 (11%), subacute in 61 (64%), and late in 24 (25%) patients. Procedural and clinical outcomes of emergency PCI for treatment of stent thrombosis were investigated. Emergency PCI was successful in 86 (91%), complicated by death in 2 (2%), and coronary artery bypass grafting in 2 (2%) patients. Myocardial infarction occurred in 77 (81%) patients with a peak creatine kinase level of 1466+/-1570 U/L. Left ventricular ejection fraction declined from 0.54+/-0.19 prior to 0.48+/-0.16 (P<0.05) at the time of stent thrombosis after emergency PCI. A 6 month major adverse clinical events comprised death (11%), reinfarction (16%), and recurrent stent thrombosis (12%) after emergency PCI. Multivariable logistic regression analysis identified the achievement of TIMI 3 flow (OR=0.1, CI 95% 0.01-0.54, P<0.001) and diameter stenosis <50% (OR=0.06, CI 95% 0.01-0.32, P<0.001) during emergency PCI to be independently associated with a reduced risk of cardiac death. Recurrent stent thrombosis was independently predicted by the omission of abciximab (OR=4.3, CI 95% 1.1-17.5).
  
  
  CONCLUSIONS
  Emergency PCI for treatment of stent thrombosis effectively restores vessel patency and flow. Patients presenting with stent thrombosis are at risk for recurrent myocardial infarction and recurrent stent thrombosis.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, 3010 Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Christoph
authors.initials: C
authors.lastname: Rey
authors.forename: Franz R
authors.initials: FR
authors.lastname: Eberli
authors.forename: Mario
authors.initials: M
authors.lastname: Togni
authors.forename: David
authors.initials: D
authors.lastname: Tüller
authors.forename: Stefan
authors.initials: S
authors.lastname: Locher
authors.forename: Andrea
authors.initials: A
authors.lastname: Remondino
authors.forename: Christian
authors.initials: C
authors.lastname: Seiler
authors.forename: Otto M
authors.initials: OM
authors.lastname: Hess
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D055502:Secondary Prevention; D015607:Stents / Q000009:adverse effects*; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077466:Tirofiban; D000077284:Abciximab