title: Angiographic predictors of 2-year stent thrombosis in patients receiving drug-eluting stents: Insights from the ADAPT-DES study.
abstract: OBJECTIVE
  We sought to identify angiographic predictors of 2-year stent thrombosis (ST) in the ADAPT-DES study.
  
  
  BACKGROUND
  A strong relationship between platelet reactivity and ST after implantation of drug-eluting stents (DES) was recently confirmed in the prospective, multicenter ADAPT-DES study.
  
  
  METHODS
  In a pre-specified analysis of patients enrolled in ADAPT-DES, an independent angiographic core laboratory performed detailed angiographic analyses for all cases of ST. Patients with Academic Research Consortium definite/probable target-lesion ST were matched with controls in a 1:2 ratio, and multivariable Cox regression models identified angiographic predictors of 2-year ST.
  
  
  RESULTS
  Among 8,582 patients who had successful percutaneous coronary intervention (PCI) and were included in the ADAPT-DES study, 92 (1.1%) patients had ST at 2-year follow-up. Target lesion-related ST was identified in 77 patients (82 lesions) who were clinically matched with 153 patients (196 lesions) without ST. Patients with ST were more likely to have longer target lesions, thrombus, moderate/severe calcification, American College of Cardiology/American Heart Association (ACC/AHA) type C lesions, and saphenous vein grafts. After adjustment for clinical covariates the angiographic variables that predicted ST were lesion complexity (ACC/AHA type C lesion, adjusted HR: 1.97, 95% CI: 1.19 to 3.26, P = 0.01) and presence of thrombus on index PCI (HR: 2.25, 95% CI: 1.40 to 3.59, P < 0.01).
  
  
  CONCLUSIONS
  Anatomically complex lesions and the presence of thrombus are strong predictors of 2-year ST in the DES era. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Cardiovascular Research Foundation, New York, New York.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.|Hôpital Du Sacré-Coeur De Montréal, Université De Montréal, Montréal, Québec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: Cardiovascular Research Foundation, New York, New York.|Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Redfors
authors.affiliation: Helios Amper-Klinikum, Dachau, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.affiliation: Cardiovascular Research Foundation, New York, New York.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Mayank
authors.initials: M
authors.lastname: Yadav
authors.affiliation: Cardiovascular Research Foundation, New York, New York.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.|Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Dominic P
authors.initials: DP
authors.lastname: Francese
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Rupa
authors.initials: R
authors.lastname: Parvataneni
authors.affiliation: New York Methodist Hospital, Brooklyn, New York.
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.affiliation: Cardiovascular Research Foundation, New York, New York.|Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Cardiovascular Research Foundation, New York, New York.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Cardiovascular Research Foundation, New York, New York.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D003328:Coronary Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: drug-eluting stent; percutaneous coronary intervention; stent thrombosis