Background
Stent thrombosis (ST) is an uncommon but serious complication of percutaneous coronary
intervention (PCI). The reported rate of definite ST with new generation drug-eluting
stents ranges from 0.5 to 1% at 30 days. We aimed to examine the incidence and outcomes
of ST in a real-world setting.
Methods
The Victorian Cardiac Outcomes Registry was established in 2012 as a state-wide clinical
quality registry, with all PCI capable centres contributing in 2017. Data were collected
on 41,137 consecutive PCI procedures from 2013 to 2017. We describe the patient characteristics
and clinical outcomes in definite and probable ST at 30 days.
Results
Stent thrombosis occurred in 225 patients (0.55%). Compared to patients without ST,
these patients were more likely to be female (32.0% vs 23.4%, p≤0.01) and have a history
of diabetes (28.6% vs 21.9%, p=0.02). ST was more common in patients with severely
reduced left ventricular ejection fraction (14.9% vs 4.6%, p<0.001) and in patients
presenting with ST-elevation myocardial infarction, cardiogenic shock and cardiac
arrest for their index PCI (all p<0.001). Dual antiplatelet therapy at 30 days was
less frequent in patients with ST (84.8% vs 92.0%, p<0.001), while 30-day mortality
was more common: 23.6% versus 2.0% (p<0.001).
Conclusions
Even with contemporary stents and adjunctive medications, ST still occurs following
1 in 200 PCIs, and is associated with increased mortality at 30 days.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Stent thrombosis in new-generation drug-eluting stents in patients with STEMI undergoing primary PCI: a report from SCAAR.J Am Coll Cardiol. 2014; 64: 16-24
- Stent thrombosis with everolimus-eluting stents: meta-analysis of comparative randomized controlled trials.Circ Cardiovasc Interv. 2012; 5: 357-364
- Stent thrombosis: a clinical perspective.JACC Cardiovasc Interv. 2014; 7: 1081-1092
- Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients.JACC Cardiovasc Interv. 2013; 6: 1267-1274
- Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry.J Am Coll Cardiol. 2009; 53: 1399-1409
- Rates of stent thrombosis in bare-metal versus drug-eluting stents (from a large Australian multicenter registry).J Am Cardiol. 2008; 101: 1716-1722
- Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis.JACC Cardiovasc Interv. 2012; 5: 131-140
- Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.JAMA. 2005; 293: 2126-2130
- Incidence and predictors of drug-eluting stent thrombosis during and after discontinuation of thienopyridine treatment.Circulation. 2007; 116: 745-754
- Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement.Circulation. 2006; 113: 2803-2809
- The relationship and threshold of stent length with regard to risk of stent thrombosis after drug-eluting stent implantation.JACC Cardiovasc Interv. 2010; 3: 383-389
- Chronic kidney disease and the risk of stent thrombosis after percutaneous coronary intervention with drug-eluting stents.Catheter Cardiovasc Interv. 2012; 80: 361-367
- Early and late stent thrombosis in patients with versus without diabetes mellitus following percutaneous coronary intervention with drug-eluting stents: a systematic review and meta-analysis.Am J Cardiovasc Drugs. 2018; 18: 483-492
- The establishment of the Victorian Cardiac Outcomes Registry (VCOR): monitoring and optimising outcomes for cardiac patients in Victoria.Heart Lung Circ. 2018; 27: 451-463
- Clinical end points in coronary stent trials: a case for standardized definitions.Circulation. 2007; 115: 2344-2351
- Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group.Circulation. 1990; 82: 1193-1202
- Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium.Circulation. 2011; 123: 2736-2747
- Drug-eluting stent and coronary thrombosis.Circulation. 2007; 115: 1051-1058
- Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials.Circulation. 2001; 103: 1967-1971
- Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies.J Am Coll Cardiol. 2005; 45: 954-959
- Early stent thrombosis in patients with acute coronary syndromes treated with drug-eluting and bare metal stents: the Acute Catheterization and Urgent Intervention Triage Strategy trial.Circulation. 2009; 119: 687-698
- Interplay between oxidative stress and platelet activation in coronary thrombus of STEMI patients.Antioxidants. 2018; 7: 83
- Impaired bioavailability of clopidogrel in patients with a ST-segment elevation myocardial infarction.Thromb Res. 2008; 122: 776-781
- Gender Differences in outcomes and predictors of all-cause mortality after percutaneous coronary intervention (data from United Kingdom and Sweden).J Am Coll Cardiol. 2017; 119: 210-216
- Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome.J Am Coll Cardiol. 1997; 29: 6-12
- Comparisons of baseline demographics, clinical presentation, and long-term outcome among patients with early, late, and very late stent thrombosis of sirolimus-eluting stents: Observations from the Registry of Stent Thrombosis for Review and Reevaluation (RESTART).Circulation. 2010; 122: 52-61
- Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials.Am J Med. 2006; 119: 1056-1061
- Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up.Am J Cardiol. 2006; 98: 352-356
Article info
Publication history
Published online: October 29, 2019
Accepted:
October 14,
2019
Received in revised form:
September 30,
2019
Received:
July 25,
2019
Identification
Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
