Author + information
- Received July 16, 2007
- Revision received October 17, 2007
- Accepted October 22, 2007
- Published online March 11, 2008.
- José M. de la Torre-Hernández, MD, PhD⁎,⁎ (, )
- Fernando Alfonso, MD, PhD†,
- Felipe Hernández, MD‡,
- Jaime Elizaga, MD§,
- Marcelo Sanmartin, MD, PhD∥,
- Eduardo Pinar, MD¶,
- Iñigo Lozano, MD, PhD#,
- Jose M. Vazquez, MD⁎⁎,
- Javier Botas, MD, PhD††,
- Armando Perez de Prado, MD‡‡,
- Jose M. Hernández, MD, PhD§§,
- Juan Sanchis, MD, PhD∥∥,
- Juan M. Ruiz Nodar, MD, PhD¶¶,
- Alfredo Gomez-Jaume, MD, PhD##,
- Mariano Larman, MD⁎⁎⁎,
- Jose A. Diarte, MD, PhD†††,
- Javier Rodríguez-Collado, MD‡‡‡,
- Jose R. Rumoroso, MD, PhD§§§,
- Jose R. Lopez-Minguez, MD∥∥∥,
- Josepa Mauri, MD¶¶¶,
- ESTROFA Study Group
- ↵⁎Reprint requests and correspondence:
Dr. José M. de la Torre Hernández, Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain.
Objectives This study sought to assess the incidence, predictors, and outcome of drug-eluting stent (DES) thrombosis in real-world clinical practice.
Background The DES thromboses in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications.
Methods We designed a large-scale, nonindustry-linked multicentered registry, with 20 centers in Spain. The participant centers provided follow-up data for their patients treated with DES, reporting a detailed standardized form in the event of any angiography-documented DES-associated thrombosis occurring.
Results Of 23,500 patients treated with DES, definite stent thrombosis (ST) developed in 301: 24 acute, 125 subacute, and 152 late. Of the late, 62 occurred >1 year (very late ST). The cumulative incidence was 2% at 3 years. Antiplatelet treatment had been discontinued in 95 cases (31.6%). No differences in incidences were found among stent types. Independent predictors for subacute ST analyzed in a subgroup of 14,120 cases were diabetes, renal failure, acute coronary syndrome, ST-segment elevation myocardial infarction, stent length, and left anterior descending artery stenting, and for late ST were ST-segment elevation myocardial infarction, stenting in left anterior descending artery, and stent length. Mortality at 1-year follow-up was 16% and ST recurrence 4.6%. Older age, left ventricular ejection fraction <45%, nonrestoration of Thrombolysis In Myocardial Infarction flow grade 3, and additional stenting were independent predictors for mortality.
Conclusions The cumulative incidence of ST after DES implantation was 2% at 3 years. No differences were found among stent types. Patient profiles differed between early and late ST. Short-term prognosis is poor, especially when restoration of normal flow fails.
- Received July 16, 2007.
- Revision received October 17, 2007.
- Accepted October 22, 2007.
- American College of Cardiology Foundation