title: Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses.
abstract: BACKGROUND
  Stent thrombosis remains among the most feared complications of percutaneous coronary intervention (PCI) with stenting. However, data on its incidence and predictors are sparse and conflicting. We thus aimed to perform a collaborative systematic review on incidence and predictors of stent thrombosis.
  
  
  METHODS
  PubMed was systematically searched for eligible studies from the drug-eluting stent (DES) era (1/2002-12/2010). Studies were selected if including ≥ 2000 patients undergoing stenting or reporting on ≥ 25 thromboses. Study features, patient characteristics, and incidence of stent thrombosis were abstracted and pooled, when appropriate, with random-effect methods (point estimate [95% confidence intervals]), and consistency of predictors was formally appraised.
  
  
  RESULTS
  A total of 30 studies were identified (221,066 patients, 4276 thromboses), with DES used in 87%. After a median of 22 months, definite, probable, or possible stent thrombosis had occurred in 2.4% (2.0%; 2.9%), with acute in 0.4% (0.2%; 0.6%), subacute in 1.1% (1.0%; 1.3%), late in 0.5% (0.4%; 0.6%), and very late in 0.6% (0.4%; 0.8%). Similar figures were computed for studies reporting only on DES. From a total of 47 candidate variables, definite/probable stent thrombosis was more commonly and consistently predicted by early antiplatelet therapy discontinuation, extent of coronary disease, and stent number/length, with acute coronary syndrome at admission, diabetes, smoking status, and bifurcation/ostial disease also proving frequent predictors, but less consistently.
  
  
  CONCLUSIONS
  Despite numerous possible risk factors, the most common and consistent predictors of stent thrombosis are early antiplatelet therapy discontinuation, extent of coronary disease, and stent number/length.
authors.affiliation: Division of Cardiology, University of Turin, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Mario
authors.initials: M
authors.lastname: Bollati
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Clementi
authors.forename: Davide
authors.initials: D
authors.lastname: Castagno
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
authors.forename: Jose M
authors.initials: JM
authors.lastname: de la Torre Hernandez
authors.forename: Juriën M
authors.initials: JM
authors.lastname: ten Berg
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sardi
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: John M
authors.initials: JM
authors.lastname: Lasala
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schulz
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Gilles
authors.initials: G
authors.lastname: Lemesle
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Applegate
authors.forename: Piergiovanni
authors.initials: P
authors.lastname: Buonamici
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Anetta
authors.initials: A
authors.lastname: Undas
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
mesh_terms: D003299:Cooperative Behavior; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D038622:Internationality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011237:Predictive Value of Tests; D028761:Withholding Treatment / Q000639:trends
chemical_list: D010975:Platelet Aggregation Inhibitors