Author + information
- Received August 21, 2008
- Revision received December 15, 2008
- Accepted December 18, 2008
- Published online April 21, 2009.
- Jochem W. van Werkum, MD*,†,
- Antonius A. Heestermans, MD‡,
- A. Carla Zomer, MD*,
- Johannes C. Kelder, MD*,
- Maarten-Jan Suttorp, MD, PhD*,
- Benno J. Rensing, MD, PhD*,
- Jacques J. Koolen, MD, PhD§,
- B.R. Guus Brueren, MD, PhD§,
- Jan-Henk E. Dambrink, MD, PhD‡,
- Raymond W. Hautvast, MD, PhD∥,
- Freek W. Verheugt, MD, PhD† and
- Jurriën M. ten Berg, MD, PhD*,* ()
- ↵*Reprint requests and correspondence:
Dr. Jurriën M. ten Berg, Department of Cardiology, St. Antonius Hospital, P.O. Box 2500, 3435 CM Nieuwegein, the Netherlands
Objectives This study sought to comprehensively identify predictors of stent thrombosis (ST).
Background Given the devastating consequences of ST, efforts should be directed toward risk stratification to identify patients at highest risk for ST.
Methods Consecutive patients with angiographic ST were enrolled. Patients who did not suffer from a ST were randomly selected in a 2:1 ratio and were matched for: 1) percutaneous coronary intervention (PCI) indication; 2) same date of index PCI; and 3) same interventional center.
Results Of 21,009 patients treated with either a bare-metal or drug-eluting stent, 437 patients (2.1%) presented with a definite ST. A total of 140 STs were acute, 180 were subacute, 58 were late, and 59 were very late. Undersizing of the coronary stent, Thrombolysis In Myocardial Infarction flow grade <3, present malignancy, presence of intermediate coronary artery disease proximal and distal to the culprit lesion, dissection, lack of aspirin, bifurcation lesions, ejection fraction <30%, and younger age were associated with ST. The lack of clopidogrel therapy at the time of ST in the first 30 days after the index PCI (hazard ratio [HR]: 36.5, 95% confidence interval [CI]: 8.0 to 167.8), between 30 days and 6 months after the index PCI (HR: 4.6, 95% CI: 1.4 to 15.3), and beyond 6 months (HR: 5.9, 95% CI: 1.7 to 19.8) after the index PCI was strongly associated with ST.
Conclusions Important correlates of ST were identified. Discontinuation of clopidogrel, undersizing of the coronary stent, present malignancy, and intermediate (≥50% to <70% stenosis) coronary artery disease proximal to the culprit lesion were the strongest predictors of ST.
The Dutch Stent Thrombosis Registry was supported by an unrestricted research grant from Sanofi-Aventis and Bristol-Myers Squibb. The sponsor had no role in the design and conduct of the study in the collection, management, analysis, and interpretation of the data or in the preparation, review, or approval of the manuscript. Drs. van Werkum and ten Berg served on scientific advisory boards for The Medicines Company. Dr. Verheugt received speaker fees from Sanofi-Aventis and received funding for research from Bayer and Eli Lilly. The supporting pharmaceutical company Sanofi-Aventis had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Drs. van Werkum, Heestermans, and ten Berg had full access to all data and had final responsibility for the decision to submit for publication.
- Received August 21, 2008.
- Revision received December 15, 2008.
- Accepted December 18, 2008.
- American College of Cardiology Foundation