title: Short-term consequences of angiographically-confirmed coronary stent thrombosis.
abstract: OBJECTIVE
  To conduct a meta-analysis to quantify the real-world incidence of in-hospital or 30-day death or myocardial infarction (MI), and angiographically-confirmed ST-related treatment costs.
  
  
  BACKGROUND
  The short-term clinical and economic consequences of coronary stent thrombosis (ST) are thought to be significant.
  
  
  METHODS
  We searched MEDLINE, Embase and Scopus from January 2000-July 2012 to identify observational/registry studies that evaluated a cohort of ≥ 25 patients experiencing angiographically-confirmed thrombosis of a drug-eluting or bare-metal stent, required the use of dual-antiplatelet therapy for guideline-recommended durations, and reported incidences of in-hospital or 30-day death or MI and/or ST-related treatment costs. Incidences and costs from each study were pooled using random-effects meta-analysis.
  
  
  RESULTS
  Twenty-three studies were included. Of the 13 studies reporting in-hospital outcomes, 12 (N=8,832 STs) reported mortality data, with the pooled incidence rate estimated to be 7.9%, 95%CI=5.4%-11.3%, I(2)=86%. Ten studies (N=1,294 STs) reported 30-day death, with a pooled incidence of 11.6%, 95%CI=8.8%-15.1%, I(2)=55%. Patients experiencing early ST (within 30-days of implant) had higher in-hospital and 30-day mortality than those experiencing very-late ST (interaction p<0.04 for both). Stent type had no significant effect on in-hospital or 30-day mortality. In the 5 studies (N=542 STs) and 3 studies (N=180 STs) reporting in-hospital and 30-day MI, respectively, the pooled incidence rates were 6.1%, 95%CI=2.1%-16.2%, I(2)=88% and 9.5%, 95%CI=3.8%-22.0%, I(2)=65%. One study reported costs associated with ST, estimating the median/patient cost of hospitalization to treat early ST at $11,134 (in 2000US$).
  
  
  CONCLUSIONS
  Regardless of stent type used, the short-term consequences of coronary ST appear significant.
authors.affiliation: Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, United States of America ; The Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, United States of America.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Kohn
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kluger
authors.forename: Meena
authors.initials: M
authors.lastname: Azeem
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
mesh_terms: D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors