High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis.
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.
Lemesle
Gilles
G
Service de Cardiologie B et Centre Hémodynamique, Hôpital cardiologique, CHRU de LILLE, 59037 Lille, France.
Sudre
Arnaud
A
Modine
Thomas
T
Delhaye
Cédric
C
Rosey
Guillaume
G
Gourlay
Terry
T
Bauters
Christophe
C
Lablanche
Jean-Marc
JM
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
D008670:Metals; D010975:Platelet Aggregation Inhibitors