title: Long-term clinical outcome after a first angiographically confirmed coronary stent thrombosis: an analysis of 431 cases.
abstract: 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.
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Jochem W
authors.initials: JW
authors.lastname: van Werkum
authors.forename: Antonius A C M
authors.initials: AA
authors.lastname: Heestermans
authors.forename: Fleur I
authors.initials: FI
authors.lastname: de Korte
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.forename: Maarten-Jan
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Benno J W M
authors.initials: BJ
authors.lastname: Rensing
authors.forename: Bastiaan
authors.initials: B
authors.lastname: Zwart
authors.forename: B R Guus
authors.initials: BR
authors.lastname: Brueren
authors.forename: Jacques J
authors.initials: JJ
authors.lastname: Koolen
authors.forename: Jan-Henk E
authors.initials: JH
authors.lastname: Dambrink
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van't Hof
authors.forename: Freek W A
authors.initials: FW
authors.lastname: Verheugt
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: ten Berg
mesh_terms: 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