Clinical manifestation and prognosis of early versus late stent thrombosis of drug-eluting stents.
BACKGROUND
Stent thrombosis (ST) is a serious complication of drug-eluting stents (DES), leading to catastrophic events. ST can occur early or late following the percutaneous coronary intervention (PCI) with different possible consequences.


METHODS
The records of 91 consecutive patients who presented with a definite ST (as defined by the Academic Research Consortium) from 2003 to 2007 were reviewed. Clinical presentation and outcome were compared based on the time of the event. Fifty-one patients presented with an early ST versus 40 with a late ST. The primary end-point was a composite of death-recurrent myocardial infarction (MI)-recurrent ST at 1 year.


RESULTS
Baseline characteristics were similar. Patients with early ST had more initial stent implantation for an acute MI indication and presented more with cardiogenic shock when compared to patients with late ST: 43.1% versus 17.5% (P = 0.007) and 39.2% versus 20% (P = 0.042), respectively. There was no difference in the ST treatment except for more intraaortic balloon pump (IABP) use in the early ST group (28% vs. 10%, P = 0.034). Angiographic success rates were similar. The incidence of the composite primary end-point was 52.9% in the early ST group versus 30% in the late ST group (P = 0.034).


CONCLUSIONS
Early definite ST is associated with more dramatic presentation and worse long-term prognosis when compared with definite late ST. This could be explained at least in part by the occurrence of two successive MIs within 30 days in almost 45% of the patients with early ST, leading to a higher rate of cardiogenic shock.
Lemesle
Gilles
G
Washington Hospital Center, Washington, DC 20010, USA.
De Labriolle
Axel
A
Bonello
Laurent
L
Maluenda
Gabriel
G
Torguson
Rebecca
R
Xue
Zhenyi
Z
Satler
Lowell F
LF
Lindsay
Joseph
J
Pichard
Augusto D
AD
Waksman
Ron
R
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000401:mortality / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D011379:Prognosis; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors