Author + information
- Received April 20, 1995
- Revision received August 11, 1995
- Accepted August 17, 1995
- Published online January 1, 1996.
- Franz-Josef Neumann, MDa,**,
- Meinrad Gawaz, MDa,
- Ilka Ott, MDa,
- Andreas May, MDa,
- Georg Mössmer, MD* and
- Albert Schömig, MDa
- ↵**Address for correspondence: Dr. Franz-Josef Neumann, 1. Medizinische Klinik der Technischen Universität München, Klinikum rechts der Isar, Ismaninger Straβe 22, 81675 München, Germany.
Objectives. This study sought to investigate hemostatic predictors of subacute occlusive coronary stent thrombosis.
Background. Better hemostatic monitoring may improve antithrombotic therapy after stenting.
Methods. In 140 consecutive patients undergoing PalmazSchatz stent implantation for suboptimal angioplasty results, we obtained serial blood samples immediately before and daily for 12 days after stenting. We prospectively tested the hypothesis that subacute stent thrombosis was more frequent if the surface expression of the inducible fibrinogen receptor on platelets (flow cytometry) or the concentration of plasma fibrinogen or that of the prothrombin fragments F1+2before stent implantation exceeded the 75th percentile of the entire study cohort.
Results. All five stent occlusions encountered during the study occurred in patients with platelet fibrinogen receptor expression above the 75th percentile. Thus, the rate of stent occlusion differed significantly between the groups defined by platelet fibrinogen receptor expression (14.3% vs. 0%, p = 0.0008). In both the group with fibrinogen concentration and that with F1+2concentration above the 75th percentile, three stent occlusions occurred. Between the groups defined by these variables, the rate of stent occlusion did not differ significantly (8.6% vs. 1.9%, p = 0.10). Logistic regression analysis, including angiographic and hemostatic variables, confirmed platelet fibrinogen receptor expression as an independent predictor of stent occlusion (p = 0.020). Stent occlusion could not be predicted by the time course of any of the hemostatic variables.
Conclusions. Platelet fibrinogen receptor expression is an independent predictor of subacute stent occlusion. However, fibrinogen and F1+2concentrations do not show a strong relation to the risk of stent occlusion.
This study was supported by a grant from Johnson & Johnson Interventional Products, Hamburg, Germany.
- Received April 20, 1995.
- Revision received August 11, 1995.
- Accepted August 17, 1995.
- American College of Cardiology