title: Stent thrombosis after primary angioplasty for STEMI in relation to non-adherence to dual antiplatelet therapy over time: results of the HORIZONS-AMI trial.
abstract: OBJECTIVE
  Rates of stent thrombosis (ST) after ST-elevation myocardial infarction (STEMI) may vary over time and the relationship of this complication with non-adherence to dual antiplatelet therapy (DAPT) during long-term follow-up remains unclear.
  
  
  RESULTS
  We analysed 2,997 patients who were treated with at least one stent and in whom a non-target vessel ST did not occur during follow-up from the large-scale Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial of patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Aspirin was prescribed indefinitely, and a thienopyridine for at least six months. DAPT usage was evaluated according to the development of ST in four time periods (<1 month, 1-6 months, 6-12 months and >1 year from index stent implantation). DAPT non-usage was lowest within the first month, but was strongly associated with ST. During the 1-6 month period the relationship remained strong, but was absent in the 6-12 month period. Beyond one year, ST was associated with non-usage of aspirin but was paradoxically more common in patients taking a thienopyridine.
  
  
  CONCLUSIONS
  The relationship between stent thrombosis and non-adherence to DAPT varies over time. It is strong within the first month, remains important until six-month follow-up but fades afterwards. Very late ST is associated with both DAPT and aspirin alone but not with thienopyridine non-adherence.
authors: Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA. george.dangas@mssm.edu
authors: George D
authors: GD
authors: Dangas
authors: Bimmer E
authors: BE
authors: Claessen
authors: Roxana
authors: R
authors: Mehran
authors: Ke
authors: K
authors: Xu
authors: Gregg W
authors: GW
authors: Stone
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D017239:Paclitaxel; D010349:Patient Compliance; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D017239:Paclitaxel; D001241:Aspirin