title: Observations and outcomes of definite and probable drug-eluting stent thrombosis seen at a single hospital in a four-year period.
abstract: Stent thrombosis (ST) is a major safety concern after drug-eluting stent (DES) deployment, resulting in significant morbidity and mortality. The goal of this study was to examine the incidence, timing, clinical correlates, and outcomes after DES thrombosis in a real-world population. A retrospective analysis of 8,402 patients who underwent percutaneous coronary intervention and received a DES was performed. After DES implantation, 84 definite (DST) and 127 probable ST events occurred. The incidence of early DST was 0.8%, late DST was 0.4%, and very late DST was 0.4%. Multivariate analysis showed that a history of diabetes mellitus, myocardial infarction during admission, number of stents, and DES placement in a restenotic lesion were independently associated with DST. The incidence of early definite or probable ST (DPST) was 1.9%, late DPST was 1.4%, and very late DPST was 0.7%. Multivariate analysis showed that a history of diabetes, myocardial infarction during admission, cardiogenic shock, number of stents, and DES use in a restenotic lesion were independently associated with DPST. Both types of ST were associated with significantly higher rates of all-cause death, Q-wave myocardial infarction, and revascularization up to 24 months after DES implantation. In conclusion, ST after DES implantation in contemporary practice continues to occur from 30 days to 2 years at a rate > or =0.36%/year and is associated with high rates of morbidity and mortality. Diabetes mellitus, myocardial infarction, and DES use in a restenotic lesion were strongly associated with DST; therefore, careful consideration should apply when deploying a DES in these populations.
authors.affiliation: Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
authors.forename: Tina L
authors.initials: TL
authors.lastname: Pinto Slottow
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.forename: Probal K
authors.initials: PK
authors.lastname: Roy
authors.forename: Ashesh N
authors.initials: AN
authors.lastname: Buch
authors.forename: Teruo
authors.initials: T
authors.lastname: Okabe
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kaneshige
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D023903:Coronary Restenosis; D003328:Coronary Thrombosis / Q000209:etiology*; D048909:Diabetes Complications; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications; D012189:Retrospective Studies