title: Fixed and Modifiable Correlates of Drug-Eluting Stent Thrombosis From a Large All-Comers Registry: Insights From ADAPT-DES.
abstract: BACKGROUND
  Previous studies evaluating correlates of stent thrombosis (ST) have included mostly patients with bare metal stents and early-generation drug-eluting stents (DES) and have not systematically evaluated the role of intravascular ultrasound-guided stenting and high platelet reactivity on clopidogrel. The purpose of this study was to evaluate the frequency and correlates of ST in patients receiving DES, specifically examining the impact of risk factors modifiable by physician and patient behavior.
  
  
  RESULTS
  Assessment of Dual Anti-platelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a multicenter, prospective study in patients undergoing successful coronary intervention with DES in whom routine platelet reactivity testing was performed. Definite or probable ST occurred in 92 (1.1%) of 8582 patients within 2 years. Independent baseline correlates of ST included presentation with an acute coronary syndrome (hazard ratio [HR]=1.81, P=0.01), insulin-treated diabetes mellitus (HR=1.91, P=0.02), previous myocardial infarction (HR=1.75, P=0.02), and peripheral arterial disease (HR=2.01, P=0.01). Independent treatment-related correlates included use of early generation DES (HR=1.75, P=0.02), no procedural intravascular ultrasound guidance (HR=1.75, P=0.04), and premature discontinuation of dual antiplatelet therapy (HR=2.67, P=0.003); high platelet reactivity on clopidogrel trended as a correlate of ST (HR=1.49, P=0.08). The 2-year risk of ST ranged from 0.3% to 10.0% when 0 to 3 modifiable risk factors were present.
  
  
  CONCLUSIONS
  After successful DES implantation, ST occurred within 2 years in 1.1% of patients and was strongly associated with fixed and modifiable risk factors. The frequency of ST may be reduced with intravascular ultrasound -guided stenting, assiduous adherence to dual antiplatelet therapy, and adequate P2Y12 platelet receptor inhibition.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.). bbrodie89@gmail.com.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Ankit
authors.initials: A
authors.lastname: Garg
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rinaldi
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: D Christopher
authors.initials: DC
authors.lastname: Metzger
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Rupa
authors.initials: R
authors.lastname: Parvataneni
authors.affiliation: From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000077144:Clopidogrel; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D062645:Percutaneous Coronary Intervention; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D012307:Risk Factors; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018084:Ultrasonography, Interventional
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: acute coronary syndrome; drug-eluting stent; myocardial infarction; stent; thrombosis