Angiographic stent thrombosis at coronary bifurcations: short- and long-term prognosis.
OBJECTIVE
This study sought to describe the presentation, management, and outcomes of patients presenting with angiographic definite stent thrombosis (ST) at coronary bifurcations.


BACKGROUND
The development of drug-eluting stents has made it increasingly feasible to treat bifurcation lesions percutaneously. However, ST at coronary bifurcations may be associated with greater mortality than ST elsewhere.


METHODS
We analyzed a multicenter California registry comprising all cases of angiographic definite ST at 5 academic hospitals from 2005 to 2010. Stenting was defined as occurring at a bifurcation if the main vessel stent crossed a side branch ≥2.0 mm in diameter (provisional single-stent approach), or if there was a prior 2-stent bifurcation approach.


RESULTS
Among 173 cases of angiographic definite ST, we identified 20 cases of ST at coronary bifurcations. Nine of 20 bifurcation ST (45%) occurred with a stent present in both the parent and branch vessel. Eight cases had thrombus present in both the parent and side branch vessels. In-hospital mortality was much higher for subjects with bifurcation ST than ST at a nonbifurcation site (20% vs. 2%, p < 0.0001). During a median follow-up of 2.3 years, ST at a coronary bifurcation was associated with increased long-term mortality (hazard ratio [HR]: 3.3, 95% confidence interval [CI]: 1.4 to 7.7, p = 0.007) and a significantly higher risk for major adverse cardiovascular events (HR: 2.2, 95% CI: 1.04 to 4.8, p = 0.04) relative to ST at a nonbifurcation site.


CONCLUSIONS
ST at coronary bifurcations is associated with a higher in-hospital and long-term mortality than ST at nonbifurcation lesions. (Stent Thrombus in Acute Coronary Syndromes; NCT00931502).
Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California 95817, USA.
Ehrin J
EJ
Armstrong
Khung Keong
KK
Yeo
Usman
U
Javed
Ehtisham
E
Mahmud
Mitul
M
Patel
Kendrick A
KA
Shunk
John S
JS
MacGregor
Reginald I
RI
Low
Jason H
JH
Rogers
D000368:Aged; D002140:California; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000295:instrumentation* / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000473:pathology; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D013223:Statistics as Topic