Clinical predictors of stent thrombosis in the "real world" drug-eluting stent era.
BACKGROUND
Drug-eluting stents (DESs) are effective in reducing restenosis and the need for repeat revascularization procedures in patients who undergo percutaneous coronary intervention (PCI). There is however an increased concern with the safety of DES with regard to stent thrombosis (ST). We examined the incidence of ST among patients who received DES and determined the clinical predictors.


METHODS
All patients who underwent PCI in our centre were prospectively enrolled in a cardiovascular database. All cases of ST, as defined by 2006 Academic Research Consortium (ARC) hierarchical classification as definite and probable, from August 2002 to August 2006 were reviewed and analyzed. The clinical, angiographic and procedural characteristics of patients who developed ST were compared with those who did not.


RESULTS
The study population comprised 1580 patients who received DES implantation. The cumulative incidence of ST was 1.5%: acute ST 0.2%, subacute ST 0.9%, late ST 0.2% and very late ST 0.2%. Mortality and myocardial infarction occurred in 16% and 84% of patients, respectively, as a consequence of ST. Multivariate analysis showed that patients presenting with cardiogenic shock, acute coronary syndrome, presence of multivessel disease, impaired baseline TIMI flow and higher number of stents implanted per lesion were predictive of ST.


CONCLUSIONS
The incidence of DES ST in our 'real world' registry was low. There were clinical and angiographic characteristics identified as independent predictors of ST.
Tin-Hay
Eduardo L
EL
Cardiac Department, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore.
Poh
Kian-Keong
KK
Lim
Yean-Teng
YT
Low
Adrian Fatt-Hoe
AF
Lee
Chi-Hang
CH
Teo
Swee-Guan
SG
Lim
Jimmy
J
Lim
Ing-Han
IH
Tan
Huay-Cheem
HC
D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016208:Databases, Factual; D054855:Drug-Eluting Stents / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology