title: Predictors and outcomes of recurrent stent thrombosis: results from a multicenter registry.
abstract: OBJECTIVE
  The aim of this study was to determine the incidence, predictors, and outcomes of recurrent stent thrombosis (rST).
  
  
  BACKGROUND
  Patients who had an initial stent thrombosis (ST) develop may be at high risk of rST.
  
  
  METHODS
  We analyzed a multicenter California registry of angiographic definite ST at 5 academic hospitals from 2005 to 2013. A detailed review of the angiogram and procedure was performed of patients with and without rST.
  
  
  RESULTS
  Among 221 patients with a median follow-up of 3.3 years, definite or probable rST developed in 29, including 19 with angiographic definite rST. The cumulative hazard ratio (HR) of definite or probable rST was 16% at 1 year and 24% at 5 years, whereas the cumulative HR of angiographic definite rST was 11% at 1 year and 20% at 5 years. Despite similar angiographic results, patients who had rST develop had significantly greater peak creatine kinase at the time of initial ST (mean, 2,655 mg/dl vs. 1,654 mg/dl; p = 0.05) than those without rST. The 3-year rate of major adverse cardiovascular events was 50% for patients with rST compared with 22% for patients with a single ST (p = 0.01). After multivariable adjustment, independent predictors of definite/probable rST were age (HR: 1.4; 95 confidence interval [CI]: 1.1 to 1.8 per 10 years), bifurcation ST (HR: 4.4; 95% CI: 1.8 to 10.9), and proximal vessel diameter (HR: 1.8; 95% CI: 1.1 to 3.2 per millimeter).
  
  
  CONCLUSIONS
  rST represents an important cause of long-term morbidity and mortality after an initial ST. Bifurcation ST and a larger proximal reference vessel diameter are independently associated with an increased risk of rST.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Colorado-Denver, Denver, Colorado. Electronic address: ehrin.armstrong@gmail.com.
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California-Davis, Davis, California.
authors.forename: Shiv
authors.initials: S
authors.lastname: Sab
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California-Davis, Davis, California.
authors.forename: Gagan D
authors.initials: GD
authors.lastname: Singh
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California-Davis, Davis, California.
authors.forename: Wayland
authors.initials: W
authors.lastname: Lim
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California-Davis, Davis, California; Department of Cardiology, National Heart Centre, Singapore.
authors.forename: Khung-Keong
authors.initials: KK
authors.lastname: Yeo
authors.affiliation: Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Waldo
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California.
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California.
authors.forename: Ryan
authors.initials: R
authors.lastname: Reeves
authors.affiliation: Department of Medicine, Division of Cardiology, University of California-San Francisco, San Francisco, California.
authors.forename: John S
authors.initials: JS
authors.lastname: MacGregor
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California-Davis, Davis, California.
authors.forename: Reginald I
authors.initials: RI
authors.lastname: Low
authors.affiliation: Department of Medicine, Division of Cardiology, University of California-San Francisco, San Francisco, California; Department of Medicine, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Kendrick A
authors.initials: KA
authors.lastname: Shunk
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California.
authors.forename: Ehtisham
authors.initials: E
authors.lastname: Mahmud
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California-Davis, Davis, California.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Rogers
mesh_terms: D000367:Age Factors; D000368:Aged; D002140:California / Q000453:epidemiology; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: angiography; recurrent stent thrombosis; stent thrombosis