Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry.
OBJECTIVE
This study sought to comprehensively identify predictors of stent thrombosis (ST).


BACKGROUND
Given the devastating consequences of ST, efforts should be directed toward risk stratification to identify patients at highest risk for ST.


METHODS
Consecutive patients with angiographic ST were enrolled. Patients who did not suffer from a ST were randomly selected in a 2:1 ratio and were matched for: 1) percutaneous coronary intervention (PCI) indication; 2) same date of index PCI; and 3) same interventional center.


RESULTS
Of 21,009 patients treated with either a bare-metal or drug-eluting stent, 437 patients (2.1%) presented with a definite ST. A total of 140 STs were acute, 180 were subacute, 58 were late, and 59 were very late. Undersizing of the coronary stent, Thrombolysis In Myocardial Infarction flow grade <3, present malignancy, presence of intermediate coronary artery disease proximal and distal to the culprit lesion, dissection, lack of aspirin, bifurcation lesions, ejection fraction <30%, and younger age were associated with ST. The lack of clopidogrel therapy at the time of ST in the first 30 days after the index PCI (hazard ratio [HR]: 36.5, 95% confidence interval [CI]: 8.0 to 167.8), between 30 days and 6 months after the index PCI (HR: 4.6, 95% CI: 1.4 to 15.3), and beyond 6 months (HR: 5.9, 95% CI: 1.7 to 19.8) after the index PCI was strongly associated with ST.


CONCLUSIONS
Important correlates of ST were identified. Discontinuation of clopidogrel, undersizing of the coronary stent, present malignancy, and intermediate (>or=50% to <70% stenosis) coronary artery disease proximal to the culprit lesion were the strongest predictors of ST.
van Werkum
Jochem W
JW
Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Heestermans
Antonius A
AA
Zomer
A Carla
AC
Kelder
Johannes C
JC
Suttorp
Maarten-Jan
MJ
Rensing
Benno J
BJ
Koolen
Jacques J
JJ
Brueren
B R Guus
BR
Dambrink
Jan-Henk E
JH
Hautvast
Raymond W
RW
Verheugt
Freek W
FW
ten Berg
Jurriën M
JM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications*; D003328:Coronary Thrombosis / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors