title: Triggering mechanisms of stent thrombosis.
abstract: OBJECTIVE
  The aim of this study was to determine the role of potential triggers of stent thrombosis.
  
  
  RESULTS
  Patients (n = 437) with "definite" ST were recruited consecutively in the setting of a large multicentre observational cohort study. Patients were interviewed with validated questionnaires to identify one of the following triggers: i) timing of onset of ST, ii) performance of vigorous ( ≥ 6 MET) physical activity in the two hours preceding ST, iii) presence of emotional stress (experiencing a serious life event in the 14 days preceding the ST or feelings of anger in the 12 hours of ST) and iv) presence of a documented active infection at the time of ST. A total of 363 patients (83.1%) were able to supply adequate information. A significant trigger was identified in 83 patients (22.9%). Analysis of the different categories according to timing of ST revealed a higher prevalence of triggers with an increasing time-interval between index PCI and ST. Analysis of circadian variation showed a steep peak incidence from 7 am-12 pm.
  
  
  CONCLUSIONS
  Triggering mechanisms such as time of the day, physical exertion, emotional stress and infection may play an important role in a considerable number of patients presenting with ST, in particular in patients with (very) late ST.
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Bastiaan
authors.initials: B
authors.lastname: Zwart
authors.forename: Jochem W
authors.initials: JW
authors.lastname: van Werkum
authors.forename: Antonius A C M
authors.initials: AA
authors.lastname: Heestermans
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.forename: A Carla
authors.initials: AC
authors.lastname: Zomer
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van 't Hof
authors.forename: Freek W A
authors.initials: FW
authors.lastname: Verheugt
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: Ten Berg
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation*; D016009:Chi-Square Distribution; D003141:Communicable Diseases / Q000150:complications; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D005082:Physical Exertion; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013315:Stress, Psychological / Q000150:complications; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000209:etiology* / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome