title: Predictors and clinical implications of stent thrombosis in patients with ST-segment elevation myocardial infarction: Insights from the EXAMINATION trial.
abstract: BACKGROUND
  Few data are available about safety of second generation drug eluting stents in an all-comer ST elevation myocardial infarction (STEMI) population. We sought to investigate the predictors and clinical implications of 1-year stent thrombosis (ST) in patients with STEMI, included in the EXAMINATION trial.
  
  
  RESULTS
  The EXAMINATION trial is an all-comer prospective, randomized 1:1 controlled trial, testing everolimus-eluting stent (EES) vs. cobalt chromium bare metal stent (BMS) in STEMI patients. It included 1498 patients, randomized to EES (n = 751) or BMS (n = 747). At 1 year, definite/probable stent thrombosis, defined according to ARC criteria, occurred in 26 patients (1.73%), including 18 definite and 8 probable events. The incidence of ST was lower in patients treated with EES than in those treated with BMS (HR 0.16, 95% CI 0.03-0.29, p = 0.017). Patients with ST have higher 1-year rates of cardiac death (30.8% vs. 2.5%, p<0.001), myocardial infarction (30.8% vs. 0.5%, p<0.001) and target vessel revascularization (65.4% vs. 4.2%, p<0.001) compared with those without. Independent predictors of 1-year definite/probable ST were BMS implantation at the index procedure (HR 3.41, 95% CI 1.35-8.60), ST segment resolution of at least 70% in the EKG post-PCI (HR 0.30, 95% CI 0.13-0.70) and Killip class on admission (HR 2.57, 95% CI 1.70-3.90).
  
  
  CONCLUSIONS
  ST had low frequency in the first year after implantation of EES/BMS in STEMI patients, but it is associated with adverse events. BMS implantation, lack of ST-segment resolution and high Killip class on admission were independent predictors of 1-year ST.
authors.affiliation: University Hospital Clinic, IDIBAPS, Barcelona, Spain.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.forename: Manel
authors.initials: M
authors.lastname: Sabate
authors.forename: Victoria
authors.initials: V
authors.lastname: Martin-Yuste
authors.forename: Monica
authors.initials: M
authors.lastname: Masotti
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Shiratori
authors.forename: Luis
authors.initials: L
authors.lastname: Alvarez-Contreras
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.forename: Andrés
authors.initials: A
authors.lastname: Iñiguez
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernandez-Antolin
authors.forename: Vicente
authors.initials: V
authors.lastname: Mainar
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Tespili
authors.forename: Pieter
authors.initials: P
authors.lastname: den Heijer
authors.forename: Armando
authors.initials: A
authors.lastname: Bethencourt
authors.forename: Nicolás
authors.initials: N
authors.lastname: Vazquez
authors.forename: Josep
authors.initials: J
authors.lastname: Gomez-Lara
authors.forename: Bianca
authors.initials: B
authors.lastname: Backx
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D016037:Single-Blind Method; D013927:Thrombosis / Q000209:etiology*
keywords: Everolimus-eluting stent; STEMI; Stent thrombosis