Stent thrombosis: a poor man's disease?
BACKGROUND
Stent thrombosis is a rare but devastating complication of coronary stent implantation. The incidence and potential predictors were assessed in a "real world" single center.


OBJECTIVE
To examine whether socioeconomic status indeed affects the occurrence of stent thrombosis.


METHODS
We searched our database for cases of "definite" stent thrombosis (according to the ARC Dublin definitions). Each case was matched by procedure date, age and gender with three cases of stenting that did not result in stent thrombosis. Demographic and clinical parameters were compared and socioeconomic status was determined according to a standardized polling and market survey database.


RESULTS
A total of 3401 patients underwent stent implantation in our hospital during the period 2004-2006. Their mean age was 63 +/- 11 years, and 80% were males. Twenty-nine cases (0.85%) of "definite" sub-acute/late stent thrombosis were recorded. Mortality at 30 days was recorded in 1 patient (3.5%). Thrombosis occurred 2 days to 3 years after stent implantation. All patients presented with acute myocardial infarction. Premature clopidogrel discontinuation was reported in 60%. Patients with stent thrombosis had significantly higher rates of AMI at the time of the initial procedure (76 vs. 32%, P < 0.001) and were cigarette smokers (60 vs. 28%, P < 0.001). Drug-eluting stents were used less in the stent thrombosis group. There was no difference in stent diameter or length between the two groups. Socioeconomic status was significantly lower in the stent thrombosis group, 3.4 +/- 2.4 vs. 5.4 +/- 2.6 (mean +/- SD, scale 1-10, P < 0.01).


CONCLUSIONS
The incidence rate of stent thrombosis is at least 0.85% in our population. It appears in patients with significantly lower socioeconomic status and with certain clinical predictors. These results warrant stricter follow-up and support the policy of healthcare providers regarding patients at risk for stent thrombosis.
Danenberg
Haim D
HD
Department of Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. danen@md.huji.ac.il
Marincheva
Greghana
G
Varshitzki
Boris
B
Nassar
Hisham
H
Lotan
Chaim
C
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D015331:Cohort Studies; D003327:Coronary Disease / Q000628:therapy; D003627:Data Interpretation, Statistical; D048909:Diabetes Complications; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006798:Housing; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011138:Polytetrafluoroethylene; D012112:Residential Facilities; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors
D008670:Metals; D010975:Platelet Aggregation Inhibitors; D011138:Polytetrafluoroethylene; D000077144:Clopidogrel; D013988:Ticlopidine