title: A risk scoring system to predict coronary stent thrombosis.
abstract: OBJECTIVE
  Stent thrombosis (ST) is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We aimed to develop a scoring system to predict the risk of ST following PCI.
  
  
  METHODS
  Odds ratios (ORs) for risk factors associated with ST were identified from a meta-analysis based on a systematic literature review, and through consensus expert opinion (Delphi-RAND method). The combined ORs were used to calculate risk scores for acute (within 24 hours), early (within 30 days) and late (31 days to 1 year) ST. Risk scores were validated against patient-level data from the TRITON-TIMI 38 study. Twenty risk factors were identified.
  
  
  RESULTS
  The most highly predictive factor for early and late ST was "incomplete duration of dual antiplatelet therapy". Derived total risk scores ranged from 0 to 22 for acute and early ST, and from 0 to 20 for late ST. Increasing scores were associated with an increasing risk of ST when applied to trial data. Model discrimination was 0.60 (p = .0028), 0.67 (p < .0001) and 0.66 (p < .0001) for acute, early and late ST respectively, indicating good discriminatory power for predicting ST. Key limitations included a lack of published data on acute ST, resulting in a risk score for this time point being based predominantly on expert opinion, and that it was not possible to map all risk factors to variables collected in the TRITON-TIMI 38 study.
  
  
  CONCLUSIONS
  Our weighted scoring system may help to stratify ST risk and individualize antiplatelet therapy in patients undergoing PCI.
authors.affiliation: a St George's University Hospitals NHS Foundation Trust, Epsom and St Helier University Hospitals NHS Trust, Epsom Hospital , Epsom , UK.
authors.forename: Nikesh
authors.initials: N
authors.lastname: Malik
authors.affiliation: b University Hospitals of Leicester , Leicester , UK.
authors.forename: Amerjeet S
authors.initials: AS
authors.lastname: Banning
authors.affiliation: c Lilly UK , Windlesham, Surrey , UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Belger
authors.affiliation: c Lilly UK , Windlesham, Surrey , UK.
authors.forename: Walid
authors.initials: W
authors.lastname: Fakhouri
authors.affiliation: d Eli Lilly Australia Pty Ltd. , Sydney , NSW , Australia.
authors.forename: Peita L
authors.initials: PL
authors.lastname: Graham-Clarke
authors.affiliation: e John Radcliffe Hospital , Oxford , UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Banning
authors.affiliation: f Bristol Heart Institute, University Hospitals Bristol , Bristol , UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Baumbach
authors.affiliation: g Leeds Teaching Hospitals , Leeds , UK.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackman
authors.affiliation: h Brighton & Sussex University Hospitals , Brighton , UK.
authors.forename: Adam
authors.initials: A
authors.lastname: de Belder
authors.affiliation: i Institut Cardiovasculaire Paris Sud , Massy , France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: j Liverpool Heart and Chest Hospital , Liverpool , UK.
authors.forename: Rod
authors.initials: R
authors.lastname: Stables
authors.affiliation: k Freeman Hospital and Newcastle University , Newcastle-upon-Tyne , UK.
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.affiliation: b University Hospitals of Leicester , Leicester , UK.
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Gershlick
mesh_terms: D023903:Coronary Restenosis / Q000175:diagnosis / Q000453:epidemiology; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012107:Research Design; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors
keywords: Delphi–RAND panel; meta-analysis; risk factors; scoring system; stent thrombosis; systematic review