Circulation. 2004;109:1930-1932
Published online before print April 12, 2004, doi: 10.1161/01.CIR.0000127105.99982.21
Published online before print April 12, 2004, doi: 10.1161/01.CIR.0000127105.99982.21
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(Circulation. 2004;109:1930-1932.)
© 2004 American Heart Association, Inc.
Brief Rapid Communications |
Stent Thrombosis After Successful Sirolimus-Eluting Stent Implantation
From the Section of Interventional Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass.
Correspondence to Joseph P. Carrozza, Jr, MD, Chief, Interventional Cardiology Section, 330 Brookline Ave, Boston, MA 02215. E-mail jcarrozz{at}bidmc.harvard.edu
Received January 23, 2004; revision received March 10, 2004; accepted March 11, 2004.
Background— Stent thrombosis (ST) is a rare but devastating complication of coronary stent implantation, occurring in 0.5% to 1.9% of patients with bare metal stents. The incidence of ST with drug-eluting stents is less well studied, particularly among patients outside of clinical trials.
Methods and Results— The aim of this study was to evaluate the incidence and potential risk factors for ST in patients receiving sirolimus-eluting stents (SES) in the "real world" after commercial release in the United States in April 2003. All 652 patients who underwent SES implantation (776 lesions treated) at our institution between April and October 2003 were followed up prospectively after the procedure (median follow-up 100 days). During that period, 7 patients (1.1%, 95% CI 0.4% to 2.2%) developed ST within a range of 2 to 13 days, and 1 patient had an ST-elevation myocardial infarction on day 39 with evidence of thrombus within the SES at angiography. Patients with an ST had significantly smaller final nominal balloon diameters (2.75 versus 3.00 mm, P=0.04), and in 4 (57%) of the 7 patients with ST versus 1.7% of patients without ST (P<0.001), antiplatelet therapy had been discontinued after the procedure. Among the ST patients, 1 died and 5 had myocardial infarctions.
Conclusions— In this single-center experience, the incidence of ST after SES implantation was 
1%, which is within the expected range of bare metal stents. The discontinuation of antiplatelet therapy was strongly associated with the development of ST in this patient population.
Key Words: revascularization • thrombosis • stents
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