Long-term clinical outcome after a first angiographically confirmed coronary stent thrombosis: an analysis of 431 cases.
BACKGROUND
There are limited data on the long-term clinical outcome after an angiographically confirmed (definite) stent thrombosis (ST).


RESULTS
Four hundred thirty-one consecutive patients with a definite ST were enrolled in this multicenter registry. The primary end point was the composite of cardiac death and definite recurrent ST. Secondary end points were all-cause death, cardiac death, definite recurrent ST, definite and probable recurrent ST, any myocardial infarction, and any target-vessel revascularization. The primary end point occurred in 111 patients after a median follow-up of 27.1 months. The estimated cumulative event rates at 30 days and 1, 2, and 3 years were 18.0%, 23.6%, 25.2%, and 27.9%, respectively. The cumulative incidence rates of definite recurrent ST, definite or probable recurrent ST, any myocardial infarction, and any target-vessel revascularization were 18.8%, 20.1%, 21.3%, and 32.0%, respectively, at the longest available follow-up. Independent predictors for the primary end point were diabetes mellitus, total stent length, severe calcification, American College of Cardiology/American Heart Association B2-C lesions, TIMI (Thrombolysis In Myocardial Infarction) flow grade <3 after percutaneous coronary intervention, and left ventricular ejection fraction <45%. The implantation of an additional coronary stent during the first ST was also associated with unfavorable outcome. Clinical outcome was not affected by the type of previously implanted stent (drug-eluting or bare-metal stent) or the category of ST (early versus late).


CONCLUSIONS
The long-term clinical outcome after a first definite ST is unfavorable, with a high mortality and recurrence rate. Diabetes mellitus, left ventricular ejection fraction <45%, long total stent length, complex coronary lesions, TIMI flow grade <3 after percutaneous coronary intervention, and implantation of an additional coronary stent during the emergent percutaneous coronary intervention for the ST were associated with this unfavorable outcome.
van Werkum
Jochem W
JW
Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands.
Heestermans
Antonius A C M
AA
de Korte
Fleur I
FI
Kelder
Johannes C
JC
Suttorp
Maarten-Jan
MJ
Rensing
Benno J W M
BJ
Zwart
Bastiaan
B
Brueren
B R Guus
BR
Koolen
Jacques J
JJ
Dambrink
Jan-Henk E
JH
van't Hof
Arnoud W J
AW
Verheugt
Freek W A
FW
ten Berg
Jurriën M
JM
D000368:Aged; D000792:Angiography; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome