Incidence and predictors of drug-eluting stent thrombosis during and after discontinuation of thienopyridine treatment.
BACKGROUND
The need for prolonged aspirin and thienopyridine therapy and the risk of stent thrombosis (ST) remain as drawbacks associated with drug-eluting stents.


RESULTS
A prospective observational cohort study was conducted between June 2002 and January 2004 on 3021 patients consecutively and successfully treated in 5389 lesions with drug-eluting stents. Detailed patient information was collected on antiplatelet therapy. We analyzed the incidence of ST throughout the 18-month follow-up period and its relationship with thienopyridine therapy. ST occurred in 58 patients (1.9%) at 18 months. Forty-two patients (1.4%) experienced the event within 6 months of stent implantation. Acute myocardial infarction (fatal or nonfatal) occurred in 46 patients (79%) and death in 23 patients (39%) with ST. The median interval from discontinuation of thienopyridine therapy to ST was 13.5 days (interquartile range 5.2 to 25.7 days) for the first 6 months and 90 days (interquartile range 30 to 365 days) between 6 and 18 months. On multivariable analysis, the strongest predictor for ST within 6 months of stenting was discontinuation of thienopyridine therapy (hazard ratio, 13.74; 95% CI, 4.04 to 46.68; P<0.001). Thienopyridine discontinuation after 6 months did not predict the occurrence of ST (hazard ratio, 0.94; 95% CI, 0.30 to 2.98; P=0.92).


CONCLUSIONS
Discontinuation of thienopyridine therapy was the major determinant of ST within the first 6 months, but insufficient information is available to determine whether there is benefit in continuing a thienopyridine beyond 6 months.
Invasive Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Flavio
F
Airoldi
Antonio
A
Colombo
Nuccia
N
Morici
Azeem
A
Latib
John
J
Cosgrave
Lutz
L
Buellesfeld
Erminio
E
Bonizzoni
Mauro
M
Carlino
Ulrich
U
Gerckens
Cosmo
C
Godino
Gloria
G
Melzi
Iassen
I
Michev
Matteo
M
Montorfano
Giuseppe Massimo
GM
Sangiorgi
Asif
A
Qasim
Alaide
A
Chieffo
Carlo
C
Briguori
Eberhard
E
Grube
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use*; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D017239:Paclitaxel; D001241:Aspirin; D020123:Sirolimus