Related Experiment Videos
Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry
Jochem W van Werkum1, Antonius A Heestermans, A Carla Zomer
1Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Insights
Identifying predictors of stent thrombosis (ST) is crucial for patient risk stratification. Key factors include clopidogrel discontinuation, undersized stents, malignancy, and intermediate coronary artery disease, which strongly predict ST events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Stent thrombosis (ST) carries severe consequences, necessitating effective risk stratification.
- Identifying patients at high risk for ST is essential for preventative strategies.
Purpose of the Study:
- To comprehensively identify predictors of stent thrombosis (ST).
- To aid in risk stratification for patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A case-control study involving consecutive patients with angiographic ST.
- Control patients without ST were matched 2:1 for PCI indication, index PCI date, and interventional center.
Main Results:
- Out of 21,009 patients, 437 (2.1%) experienced definite ST, with varying acute, subacute, late, and very late presentations.
- Predictors of ST included stent undersizing, low Thrombolysis In Myocardial Infarction flow, malignancy, intermediate coronary artery disease, dissection, lack of aspirin, bifurcation lesions, low ejection fraction, and younger age.
- Discontinuation of clopidogrel therapy at all time points post-PCI was strongly associated with ST.
Conclusions:
- Several important correlates of ST were identified.
- The strongest predictors of ST were clopidogrel discontinuation, coronary stent undersizing, malignancy, and intermediate coronary artery disease proximal to the culprit lesion.
Objectives:
This study sought to comprehensively identify predictors of stent thrombosis (ST).
Background:
Given the devastating consequences of ST, efforts should be directed toward risk stratification to identify patients at highest risk for ST.
Methods:
Consecutive patients with angiographic ST were enrolled. Patients who did not suffer from a ST were randomly selected in a 2:1 ratio and were matched for: 1) percutaneous coronary intervention (PCI) indication; 2) same date of index PCI; and 3) same interventional center.
Results:
Of 21,009 patients treated with either a bare-metal or drug-eluting stent, 437 patients (2.1%) presented with a definite ST. A total of 140 STs were acute, 180 were subacute, 58 were late, and 59 were very late. Undersizing of the coronary stent, Thrombolysis In Myocardial Infarction flow grade <3, present malignancy, presence of intermediate coronary artery disease proximal and distal to the culprit lesion, dissection, lack of aspirin, bifurcation lesions, ejection fraction <30%, and younger age were associated with ST. The lack of clopidogrel therapy at the time of ST in the first 30 days after the index PCI (hazard ratio [HR]: 36.5, 95% confidence interval [CI]: 8.0 to 167.8), between 30 days and 6 months after the index PCI (HR: 4.6, 95% CI: 1.4 to 15.3), and beyond 6 months (HR: 5.9, 95% CI: 1.7 to 19.8) after the index PCI was strongly associated with ST.
Conclusions:
Important correlates of ST were identified. Discontinuation of clopidogrel, undersizing of the coronary stent, present malignancy, and intermediate (>or=50% to <70% stenosis) coronary artery disease proximal to the culprit lesion were the strongest predictors of ST.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:26Coronary Artery Disease IV: Preventive Measures
01:30Coronary Artery Disease I: Introduction