title: High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis.
abstract: OBJECTIVE
  We attempted to investigate incidence and predictors of recurrent in stent thrombosis (IST) after successful treatment of a first IST.
  
  
  BACKGROUND
  The occurrence of recurrent IST after successful treatment of a first IST may be a decisive factor for patient clinical outcome. However, incidence and predictors of recurrent IST are currently poorly described in the literature.
  
  
  METHODS
  Between 2003 and 2005, 2,190 patients underwent a percutaneous coronary intervention in our center. During a median follow-up of 19.4 months, 49 patients (2.24%) presented a first definite IST. Patients presenting with a first IST were followed during an additional median period of 40 months. Their baseline characteristics were listed and cardiovascular events especially recurrent IST as defined by the Academic Research Consortium definition were systematically indexed.
  
  
  RESULTS
  Altogether 39 (80%) patients were successfully treated with an effective reperfusion after percutaneous coronary intervention. Fourteen (36%) patients presented a recurrent IST and three presented multiple recurrent IST. The median occurrence time of recurrent IST was 5 days, range between 1 and 11 days. Multivariate analysis identified history of neoplasia (HR = 11.53, 95% CI 2.32-57.37, P = 0.003), residual diameter stenosis (HR = 1.15, 95% CI 1.02-1.29, P = 0.02), and residual dissection after treatment (HR = 8.78, 95% CI 1.85-41.62, P = 0.006), as independent predictors of recurrent IST.
  
  
  CONCLUSIONS
  Recurrent IST is a frequent and early event after successful treatment of a first IST. Our results suggest that mechanical factors like residual dissection and residual diameter stenosis should be carefully tracked down. In addition, patients with multiple recurrent IST and the early time course of recurrent IST also suggest a potential role of inadequate antiplatelet therapy.
authors.affiliation: Service de Cardiologie B et Centre Hémodynamique, Hôpital cardiologique, CHRU de LILLE, 59037 Lille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Lemesle
authors.forename: Arnaud
authors.initials: A
authors.lastname: Sudre
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
authors.forename: Cédric
authors.initials: C
authors.lastname: Delhaye
authors.forename: Guillaume
authors.initials: G
authors.lastname: Rosey
authors.forename: Terry
authors.initials: T
authors.lastname: Gourlay
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Lablanche
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D003324:Coronary Artery Disease / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008670:Metals; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals; D010975:Platelet Aggregation Inhibitors