Comparisons of baseline demographics, clinical presentation, and long-term outcome among patients with early, late, and very late stent thrombosis of sirolimus-eluting stents: Observations from the Registry of Stent Thrombosis for Review and Reevaluation (RESTART).
BACKGROUND
Stent thrombosis (ST) after sirolimus-eluting stent implantation has not yet been adequately characterized, mainly because of its low incidence.


RESULTS
The Registry of Stent Thrombosis for Review and Reevaluation (RESTART) is a Japanese nationwide registry of sirolimus-eluting stent-associated ST comprising 611 patients with definite ST (early [within 30 days; EST], 322 patients; late [between 31 and 365 days; LST], 105 patients; and very late [>1 year; VLST], 184 patients). Baseline demographics, clinical presentation, and long-term outcome of sirolimus-eluting stent-associated ST were compared among patients with EST, LST, and VLST. Baseline demographics were significantly different according to the timing of ST. Characteristic demographic factors for LST/VLST versus EST identified by multivariable model were hemodialysis, end-stage renal disease not on hemodialysis, absence of circumflex target, target of chronic total occlusion, prior percutaneous coronary intervention, and age <65 years. For LST versus VLST, they were hemodialysis, heart failure, insulin-dependent diabetes mellitus, and low body mass index. Patients with LST had a significantly higher rate of Thrombolysis in Myocardial Infarction grade 2/3 flow (36%) at the time of ST than those with EST (13%) (P<0.0001) and VLST (17%; P<0.0001). Mortality rate at 1 year after ST was significantly lower in patients with VLST (10.5%) compared with those with EST (22.4%; P=0.003) or LST (23.5%; P=0.009).


CONCLUSIONS
ST timing-dependent differences in baseline demographic features, Thrombolysis in Myocardial Infarction flow grade, and mortality rate suggest possible differences in the predominant pathophysiological mechanisms of ST according to timing after sirolimus-eluting stent implantation.
Kimura
Takeshi
T
Department of Cardiovascular of Medicine, Kyoto University, Japan. taketaka@kuhp.kyoto-u.ac.jp
Morimoto
Takeshi
T
Kozuma
Ken
K
Honda
Yasuhiro
Y
Kume
Teruyoshi
T
Aizawa
Tadanori
T
Mitsudo
Kazuaki
K
Miyazaki
Shunichi
S
Yamaguchi
Tetsu
T
Hiyoshi
Emi
E
Nishimura
Eizo
E
Isshiki
Takaaki
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D015992:Body Mass Index; D003331:Coronary Vessels / Q000601:surgery; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D054855:Drug-Eluting Stents / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D011859:Radiography; D012008:Recurrence; D012042:Registries; D006435:Renal Dialysis; D020123:Sirolimus / Q000627:therapeutic use; D013318:Stroke Volume; D013851:Thinness / Q000150:complications; D013927:Thrombosis / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome
D020123:Sirolimus