Long-Term Clinical Outcome After a First Angiographically Confirmed Coronary Stent Thrombosis

Abstract

Background-There are limited data on the long-term clinical outcome after an angiographically confirmed (definite) stent thrombosis (ST). Methods and Results-Four hundred thirty-one consecutive patients with a definite ST were enrolled in this multicenter registry. The primary end point was the composite of cardiac death and definite recurrent ST. Secondary end points were all-cause death, cardiac death, definite recurrent ST, definite and probable recurrent ST, any myocardial infarction, and any target-vessel revascularization. The primary end point occurred in 111 patients after a median follow-up of 27.1 months. The estimated cumulative event rates at 30 days and 1, 2, and 3 years were 18.0%, 23.6%, 25.2%, and 27.9%, respectively. The cumulative incidence rates of definite recurrent ST, definite or probable recurrent ST, any myocardial infarction, and any target-vessel revascularization were 18.8%, 20.1%, 21.3%, and 32.0%, respectively, at the longest available follow-up. Independent predictors for the primary end point were diabetes mellitus, total stent length, severe calcification, American College of Cardiology/American Heart Association B2-C lesions, TIMI (Thrombolysis In Myocardial Infarction) flow grade Ͻ3 after percutaneous coronary intervention, and left ventricular ejection fraction Ͻ45%. The implantation of an additional coronary stent during the first ST was also associated with unfavorable outcome. Clinical outcome was not affected by the type of previously implanted stent (drug-eluting or bare-metal stent) or the category of ST (early versus late). Conclusions-The long-term clinical outcome after a first definite ST is unfavorable, with a high mortality and recurrence rate. Diabetes mellitus, left ventricular ejection fraction Ͻ45%, long total stent length, complex coronary lesions, TIMI flow grade Ͻ3 after percutaneous coronary intervention, and implantation of an additional coronary stent during the emergent percutaneous coronary intervention for the ST were associated with this unfavorable outcome. (Circulation. 2009;119:828-834.)

Comparison of Long-Term Outcome After Percutaneous Coronary Intervention for Stent Thrombosis Between Early, Late, and Very Late Stent Thrombosis

“…In contrast, the present study also demonstrated that the clinical outcomes of stent thrombosis were similar between DES and BMS implantation, as reported in previous studies. 9 This finding was observed in EST, LST, and VLST. The present results suggest that coronary artery bypass grafting is considered early in patients with recurrent ischemic events after PCI for EST and LST, whether after DES or BMS implantation.…”

“…6,8, 9 The predictors of the composite of cardiac death and non-fatal myocardial infarction, such as post-procedural TIMI flow grade <3 and low left ventricular ejection fraction, stent sites were the other independent predictors of TLR. VLST was an independent negative predictor of the composite of cardiac death and non-fatal myocardial infarction (HR, 0.34; 95% CI: 0.16-0.73, P=0.006).…”

Long‐Term Clinical Outcomes After Angiographically Defined Very Late Stent Thrombosis of Drug‐Eluting Stent

“…One study showed unfavorable long-term clinical outcomes after definite stent thrombosis, which were associated with diabetes mellitus, left ventricular ejection fraction <45%, long total stent length, complex coronary lesions, TIMI flow grade <3 after PCI, and implantation of an additional coronary stent during primary PCI. 7 Our study also dealt with long-term clinical results, but focused on angiographically-defined VLST and not acute or subacute thrombosis; the results were also unfavorable with a 16% MACE rate and a 50% restenosis rate. It might be interesting to compare acute and subacute ST patients with late ST patients; however, data are scarce because of the rare incidence of ST, and therefore a large study would be needed.…”

A systematic review and critical assessment of 11 discordant meta-analyses on reduced-function CYP2C19 genotype and risk of adverse clinical outcomes in clopidogrel users

“…ST is associated with higher risk of experiencing MI and death, both components of the composite clinical end point. 45 The absence of consistent association with clinical end points might indicate that the alleles have no impact on distant outcomes such as MI and death and that the significant effect of ST is diluted when combining the various end points. Liu et al had performed meta-analyses on the separate clinical end points, such as bleeding complications, MI, stroke, and death, and found that effect sizes ranged from 0.99 to 1.55, with the exception of 2.37 for stroke.…”