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.
Kuchulakanti
Pramod K
PK
Division of Cardiology, Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA.
Chu
William W
WW
Torguson
Rebecca
R
Ohlmann
Patrick
P
Rha
Seung-Woon
SW
Clavijo
Leonardo C
LC
Kim
Sang-Wook
SW
Bui
Ahn
A
Gevorkian
Natalie
N
Xue
Zhenyi
Z
Smith
Kimberly
K
Fournadjieva
Jana
J
Suddath
William O
WO
Satler
Lowell F
LF
Pichard
Augusto D
AD
Kent
Kenneth M
KM
Waksman
Ron
R
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