Abstract 4480: Triggering Mechanisms of Coronary Stent Thrombosis: Data from the Dutch Stent Thrombosis Registry
Background The occurrence of stent thrombosis (ST) is only partially explained by known clinical, angiographic and procedural determinants and little is known about superimposing triggering mechanisms of ST. Given a degree of similarity in pathophysiology between ST and myocardial infarction we sought to examine the role of timing of onset, vigorous physical exertion, emotional stress and infection as potential triggers of ST.
Methods Patients (n =437) with “definite” ST were recruited consecutively in the setting of a large multicenter observational cohort study. Patients were interviewed with well-validated questionnaires to identify one of the following triggers:
timing of onset of chest pain for ST
performance of vigorous (≥ 6 MET) physical activity in the 2 hours preceding ST,
presence of emotional stress (experiencing a serious life event in the 14 days preceding the ST according to the Social Readjustment Rating Scale or feelings of anger in the 24 hours of ST) and
presence of a documented active infection at the time of ST.
Results A total of 363 patients with “definite” ST (83.1%) were able to supply adequate information. Overall, a significant trigger was identified in 83 patients (22.9%). Analysis of the different categories of ST revealed a higher prevalence of triggers with an increasing time-interval between index PCI and ST. A trigger was present in 8 (6.6%) patients with acute ST, in 40 (28.0%) patients with subacute ST, in 13 (28.3%) patients with late ST and in 22 (42.3%) patients with very late ST. Analysis of circadian variation showed a steep peak incidence of ST in the morning hours from 7–12 hours.
Conclusions Triggering mechanisms such as time of the day, physical exertion, emotional stress and infection may play an important role in a considerable number of patients presenting with ST. The prevalence of these triggers are particularly high in patients with late and very late ST.