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Updated: Jun 8, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Incidence, predictors and outcome of drug-eluting stent thrombosis in real-world practice
Miry Blich1, Tawfiq Zeidan-Shwiri, Sirouch Petcherski
1Rambam Health Care Campus, Department of Cardiology, Haalia, Haifa, 91096 Israel. m_blich@rambam.health.gov.il
Insights
Stent thrombosis (STH) occurs later than previously thought after drug-eluting stent (DES) implantation. Premature discontinuation of thienopyridines significantly increases STH risk, highlighting the need for better patient education and follow-up.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomaterials Science
Background:
- Stent thrombosis (STH) traditionally considered an early complication (<30 days) of percutaneous coronary interventions.
- Delayed endothelialization with drug-eluting stents (DES) may prolong STH risk beyond the initial post-procedural period.
- Limited data exist on STH incidence and risk factors in real-world settings outside clinical trials.
Purpose of the Study:
- To assess the incidence, predictors, and clinical outcomes of STH following DES implantation in a real-world patient cohort.
- To evaluate the rate and predictors of premature thienopyridine discontinuation after DES implantation.
Main Methods:
- Prospective data collection from consecutive patients undergoing DES implantation between February 2006 and January 2007.
- Two-year follow-up via phone interviews and medical record review to identify STH events.
- STH definition aligned with established medical literature criteria.
Main Results:
- The study included 314 patients (436 lesions) with a median follow-up of 22 months.
- STH occurred in 4.4% of patients (incidence density 2.7 cases/100 patient-years), with early, late, and very late presentations.
- History of non-cardiac thrombotic events and clopidogrel therapy <3 months were significant STH predictors. Early thienopyridine discontinuation was linked to Arab ethnicity, lack of cardiology follow-up, and inadequate discharge instructions.
Conclusions:
- Real-world STH incidence after DES implantation is higher than reported in clinical trials.
- Premature thienopyridine discontinuation is a key predictor of late and very late STH.
- Strategies to improve adherence, such as subsidizing medication costs, clear patient education, and enhanced cardiology follow-up, are crucial for reducing STH incidence.
Background:
Traditionally, stent thrombosis (STH) has been regarded as a complication of percutaneous coronary interventions during the first 30 post-procedural days. However, delayed endothelialization associated with the implantation of drug-eluting stents (DES) may extend the risk of thrombosis beyond 30 days. Data are limited regarding the risks and the impact of this phenomenon outside clinical trials.
Objectives:
To evaluate the incidence, predictors and clinical outcomes of STH and premature discontinuation of thienopyridines after implantation of DES in real-world practice.
Methods:
We prospectively collected data from consecutive unselected patients who underwent at least 1 DES implantation at our center from February 2006 until January 2007. The patients were followed by a phone interview or by collecting data from admission files over the course of 2 years after the implantation. Confirmed and suspected STH was defined as accepted in the medical literature.
Results:
Three hundred fourteen patients were successfully treated with DES (436 lesions). At 20 ± 6.7 months' follow up (median 22 months), 14 patients (4.4%) had STH (incidence density 2.7 cases/100 patients-years). Five patients had early thrombosis (0-30 days), 5 patients had late STH (31-360 days from the procedure) and 4 patients had very late STH (> 360 days). Five of the 14 patients with STH died (case fatality rate, 36%). In multivariant logistic regression analysis, history of a non-cardiac thrombotic event was a risk factor for STH (p = 0.006, odds ratio [OR] 7.7, confidence interval [CI] 1.8-32.9). Clopidogrel therapy lasting less than 3 months was an independent predictor of late and very late STH (p = 0.001, OR 10.8, CI 2.7-42.9). Independent predictors of early discontinuation of thienopyridines (≤ 3 months) were Arab ethnic origin (p = 0.005, OR 19.2, CI 2.4-142), absence of cardiology follow up (p = 0.05, OR 4.7, CI 1-23.1) and absence of explanation about the clopidogrel importance at the time of hospital discharge (p = 0.001, OR 10.8, CI 2.7-42.9).
Conclusions:
The incidence of STH at 22- month follow up in real-world patients was substantially higher than the rate reported in previous clinical trials. Subsidizing the cost of thienopyridines, providing a clear explanation to the patient and encouraging cardiology follow up may prevent premature discontinuation of thienopyridines after implantation of DES and reduce the incidence of STH after DES implantation.
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