Early Stent Thrombosis in Patients With Acute Coronary Syndromes Treated With Drug-Eluting and Bare Metal Stents

Abstract

Occurring in nearly 1 in 70 patients, early ST is relatively common in acute coronary syndromes, occurs with similar frequency after anticoagulation with either heparin plus glycoprotein IIb/IIIa inhibitors or bivalirudin with or without IIb/IIIa inhibitors, and is predicted by diffuse atherosclerosis, suboptimal angiographic results, and inadequate pharmacotherapy.

Are there sufficient standards for the in vitro hemocompatibility testing of biomaterials?

“…Atherosclerotic diseases still cannot be cured and, till today, about 50% of the population of industrial nations die from cardiovascular diseases. To restore sufficient blood flow in diseased arteries, balloon catheters with or without the implantation of endovascular stents [3,4] are routinely applied. These cardiovascular implants are selected and designed to be hemocompatible in order to fulfil their function.…”

Impact of CYP2C19 Polymorphism on Platelet Function Tests and Coagulation and Inflammatory Biomarkers in Patients Undergoing Percutaneous Coronary Intervention

“…In a recent study of healthy Westerners, the prevalence of carriers of the CYP2C19 reduced-function allele was 30% in the total study population 14) . However, adverse cardiovascular events, including stent thrombosis after primary or elective PCI, are lower in Japanese individuals than in Westerners [39][40][41] , although the frequency of carriers of at least one CYP2C19 reduced-function allele is higher in Japanese patients than Western patients. The reason for the low risk of adverse cardiovascular events, including stent thrombosis, in Japan remains unknown; however, it is possible that other factors, such as the PCI procedure, the characteristics of the culprit coronary plaques or coronary risk factors, in addition to platelet aggregation, may influence the clinical outcomes of CAD patients treated with clopidogrel.…”

Coronary Artery Disease and Diabetes Mellitus

“…9,69,71,72 In the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial, insulin-requiring DM was a significant independent predictor of definite or probable ST occurring within 30 days (odds ratio, 2.35). 73 In the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38), patients with DM and acute coronary syndrome (n = 3146) had twice the rate of stent thrombosis than those without DM (2.8% versus 1.4%, P < 0.0001), with highest rates among subjects treated with insulin (3.7%, P <0.0001). 74 …”