title: Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis.
abstract: OBJECTIVE
  The aim of this study was to describe differences in treatment and in-hospital mortality of early, late, and very late stent thrombosis (ST).
  
  
  BACKGROUND
  Early, late, and very late ST may differ in clinical presentation, management, and in-hospital outcomes.
  
  
  METHODS
  We analyzed definite (angiographically documented) ST cases identified from February 2009 to June 2010 in the CathPCI Registry. We stratified events by timing of presentation: early (≤1 month), late (1 to 12 months), or very late (≥12 months) following stent implantation. Multivariable logistic regression modeling was performed to compare in-hospital mortality for each type of ST after adjusting for baseline comorbidities.
  
  
  RESULTS
  During the study period, 7,315 ST events were identified in 7,079 of 401,662 patients (1.8%) presenting with acute coronary syndromes. This ST cohort consisted of 1,391 patients with early ST (19.6%), 1,370 with late ST (19.4%), and 4,318 with very late ST (61.0%). Subjects with early ST had a higher prevalence of black race and diabetes, whereas subjects with very late ST had a higher prevalence of white race and a lower prevalence of prior myocardial infarction or diabetes. In-hospital mortality was significantly higher in early ST (7.9%) compared with late (3.8%) and very late ST (3.6%, p<0.001). This lower mortality for late and very late ST persisted after multivariable adjustment (odds ratio: 0.53 [95% confidence interval (CI): 0.36 to 0.79] and 0.58 [95% CI: 0.43 to 0.79], respectively).
  
  
  CONCLUSIONS
  Significant differences exist in the presentation and outcomes of early, late, and very late ST. Among patients with acute coronary syndromes who are undergoing percutaneous coronary intervention for angiographically documented ST, early ST is associated with the highest in-hospital mortality.
authors.affiliation: Division of Cardiology, University of California, Davis Medical Center, Sacramento, California 95817, USA. ehrin.armstrong@gmail.com
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kaltenbach
authors.forename: Khung-Keong
authors.initials: KK
authors.lastname: Yeo
authors.forename: S Chiu
authors.initials: SC
authors.lastname: Wong
authors.forename: John
authors.initials: J
authors.lastname: Spertus
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.forename: Robert M
authors.initials: RM
authors.lastname: Minutello
authors.forename: Issam
authors.initials: I
authors.lastname: Moussa
authors.forename: Kalon K L
authors.initials: KK
authors.lastname: Ho
authors.forename: Jason H
authors.initials: JH
authors.lastname: Rogers
authors.forename: Kendrick A
authors.initials: KA
authors.lastname: Shunk
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000295:instrumentation*; D003328:Coronary Thrombosis / Q000401:mortality* / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States