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


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 (< or =30 days) in 25 patients, and late (>30 days) in 8 patients. The clinical, angiographic, 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.
Division of Cardiology, Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA.
Pramod K
PK
Kuchulakanti
William W
WW
Chu
Rebecca
R
Torguson
Patrick
P
Ohlmann
Seung-Woon
SW
Rha
Leonardo C
LC
Clavijo
Sang-Wook
SW
Kim
Ahn
A
Bui
Natalie
N
Gevorkian
Zhenyi
Z
Xue
Kimberly
K
Smith
Jana
J
Fournadjieva
William O
WO
Suddath
Lowell F
LF
Satler
Augusto D
AD
Pichard
Kenneth M
KM
Kent
Ron
R
Waksman
D000368:Aged; D000792:Angiography; D016022:Case-Control Studies; D000077144:Clopidogrel; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D051437:Renal Insufficiency / Q000150:complications; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D000077144:Clopidogrel; D013988:Ticlopidine; D017239:Paclitaxel; D020123:Sirolimus