on February 20, 2006
Circulation. 2006
Published online before print February 20, 2006, doi: 10.1161/CIRCULATIONAHA.105.600155
Published online before print February 20, 2006, doi: 10.1161/CIRCULATIONAHA.105.600155
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Submitted on August 4, 2005
From the Department of Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC. * To whom correspondence should be addressed. E-mail: ron.waksman{at}medstar.net.
Background--Stent thrombosis (ST) is a serious complication of drug-eluting stent (DES) implantation regardless of the timing (acute, subacute, or late). The correlates of ST with DES are not yet completely elucidated. Methods and Results--From a total cohort of 2974 consecutive patients treated with DES since April 2003, we identified 38 patients who presented with angiographic evidence of ST (1.27%). The ST occurred acutely in 5 patients, subacutely ( Conclusions--ST continues to be a serious complication of contemporary DES use. Careful management is warranted in patients with renal failure and in those undergoing treatment for in-stent restenosis and bifurcations. Special focus on clopidogrel compliance may minimize the incidence of ST after DES implantation.
Revised on November 7, 2005
Accepted on December 9, 2005
Correlates and Long-Term Outcomes of Angiographically Proven Stent Thrombosis With Sirolimus- and Paclitaxel-Eluting Stents
Pramod K. Kuchulakanti MD,
30 days) in 25 patients, and late (>30 days) in 8 patients. The clinical, angiographic, and procedural variables of these patients were compared with the remaining 2936 consecutive patients who underwent DES implantation and did not experience ST during a follow-up of 12 months. Logistic regression analysis was conducted to determine the correlates of ST. Compared with patients without ST, patients with ST had a higher frequency of diabetes, acute postprocedural renal failure, and chronic renal failure. There were more bifurcation lesions, type C lesions, and a trend for smaller-diameter stents. Discontinuation of clopidogrel was higher in these patients (36.8% versus 10.7%; P<0.0001). The mean duration to ST from the stent implantation was 8.9±8.5 days in subacute and 152.7±100.4 days in late thrombosis cases. Mortality was significantly higher in patients with ST compared with those without ST at 6 months (31% versus 3%; P<0.001). Multivariate analysis detected cessation of clopidogrel therapy, renal failure, bifurcation lesions, and in-stent restenosis as significant correlates of ST (P<0.05).
Key words: angioplasty • clopidogrel • stents • thrombosis
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Circulation 2006 113: 1045.
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P. W. Serruys and J. Daemen Late Stent Thrombosis: A Nuisance in Both Bare Metal and Drug-Eluting Stents Circulation, March 20, 2007; 115(11): 1433 - 1439. [Full Text] [PDF]
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T. F. Luscher, J. Steffel, F. R. Eberli, M. Joner, G. Nakazawa, F. C. Tanner, and R. Virmani Drug-Eluting Stent and Coronary Thrombosis: Biological Mechanisms and Clinical Implications Circulation, February 27, 2007; 115(8): 1051 - 1058. [Abstract] [Full Text] [PDF]
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E. A. Ashley, R. Ferrara, J. Y. King, A. Vailaya, A. Kuchinsky, X. He, B. Byers, U. Gerckens, S. Oblin, A. Tsalenko, et al. Network Analysis of Human In-Stent Restenosis Circulation, December 12, 2006; 114(24): 2644 - 2654. [Abstract] [Full Text] [PDF]
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S. Waxman, F. Ishibashi, and J. E. Muller Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events Circulation, November 28, 2006; 114(22): 2390 - 2411. [Full Text] [PDF]
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M. Pfisterer, H. P. Brunner-La Rocca, P. T. Buser, P. Rickenbacher, P. Hunziker, C. Mueller, R. Jeger, F. Bader, S. Osswald, C. Kaiser, et al. Late Clinical Events After Clopidogrel Discontinuation May Limit the Benefit of Drug-Eluting Stents: An Observational Study of Drug-Eluting Versus Bare-Metal Stents J. Am. Coll. Cardiol., November 1, 2006; (2006) j.jacc.2006.10.026v1. [Abstract] [Full Text] [PDF]
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T. T. Tsai, B. K. Nallamothu, and E. R. Bates Letter by Tsai et al Regarding Article, "Correlates and Long-Term Outcomes of Angiographically Proven Stent Thrombosis With Sirolimus- and Paclitaxel-Eluting Stents" Circulation, August 22, 2006; 114(8): e362 - e362. [Full Text] [PDF]
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A. Colombo and S. J. Corbett Drug-Eluting Stent Thrombosis: Increasingly Recognized But Too Frequently Overemphasized J. Am. Coll. Cardiol., July 4, 2006; 48(1): 203 - 205. [Full Text] [PDF]
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