Short-Term Consequences of Angiographically-Confirmed Coronary Stent Thrombosis

Abstract

ObjectivesTo conduct a meta-analysis to quantify the real-world incidence of in-hospital or 30-day death or myocardial infarction (MI), and angiographically-confirmed ST-related treatment costs.BackgroundThe short-term clinical and economic consequences of coronary stent thrombosis (ST) are thought to be significant.MethodsWe searched MEDLINE, Embase and Scopus from January 2000-July 2012 to identify observational/registry studies that evaluated a cohort of ≥25 patients experiencing angiographically-confirmed thrombosis of a drug-eluting or bare-metal stent, required the use of dual-antiplatelet therapy for guideline-recommended durations, and reported incidences of in-hospital or 30-day death or MI and/or ST-related treatment costs. Incidences and costs from each study were pooled using random-effects meta-analysis.ResultsTwenty-three studies were included. Of the 13 studies reporting in-hospital outcomes, 12 (N=8,832 STs) reported mortality data, with the pooled incidence rate estimated to be 7.9%, 95%CI=5.4%-11.3%, I2=86%. Ten studies (N=1,294 STs) reported 30-day death, with a pooled incidence of 11.6%, 95%CI=8.8%-15.1%, I2=55%. Patients experiencing early ST (within 30-days of implant) had higher in-hospital and 30-day mortality than those experiencing very-late ST (interaction p<0.04 for both). Stent type had no significant effect on in-hospital or 30-day mortality. In the 5 studies (N=542 STs) and 3 studies (N=180 STs) reporting in-hospital and 30-day MI, respectively, the pooled incidence rates were 6.1%, 95%CI=2.1%-16.2%, I2=88% and 9.5%, 95%CI=3.8%-22.0%, I2=65%. One study reported costs associated with ST, estimating the median/patient cost of hospitalization to treat early ST at $11,134 (in 2000US$).ConclusionsRegardless of stent type used, the short-term consequences of coronary ST appear significant.

Computational simulation of platelet interactions in the initiation of stent thrombosis due to stent malapposition

“…Stent thrombosis is a leading cause of stent failure, which can be fatal [4]. Stent thrombosis can occur at any time, from within 24 h of stent implantation up to several years after implantation, and may be due to vascular injury during stent implantation, thrombotic risk factors of the patient, inhibited re-endothelialization, endothelial expression of prothrombotic factors, platelet activation, or stent malapposition [5–9].…”

“…Coronary stenting is one of the most commonly used approaches to open coronary arteries blocked due to atherosclerosis, but stent failure continues to occur in 10%-20% of patients, though significant progress has been made over the last decade [1][2][3]. Stent thrombosis is a leading cause of stent failure, which can be fatal [4]. Stent thrombosis can occur at any time, from within 24 h of stent implantation up to several years after implantation, and may be due to vascular injury during stent implantation, thrombotic risk factors of the patient, inhibited re-endothelialization, endothelial expression of prothrombotic factors, platelet activation, or stent malapposition [5][6][7][8][9].…”

Simulation of the microscopic process during initiation of stent thrombosis

“…e ., aspirin plus clopidogrel) [4]. Aspirin and clopidogrel each reduce agonist-induced platelet activation and aggregation; hence, neither drug prevents shear-induced platelet activation [40, 41].…”

“…Stent thrombosis is a leading cause of stent failure, which can be fatal [4]. It is important to advance our understanding of the mechanisms of stent thrombosis.…”

Biodegradable Cable-Tie Rapamycin-eluting Stents

“…Edge dissection and stent strut fracture may occur, leading to acute stent thrombosis and even death. Furthermore, a direct correlation with stent thrombosis has been observed with increasing extensive procedures, costing on average USD 11,134 per patient 17 – 19 .…”