[en] BACKGROUND: Stent thrombosis (ST) is rare, but is associated with significant morbidity and mortality. METHODS: We analyzed data from the British Columbia (BC) Registry from April 2011-January 2012. RESULTS: 101 ST cases were reported and verified. Based on timing, ST was considered early (</=30days) in 35.6%, late (>30days-1year) in 17.8% and very late (>1year) in 46.5%. The majority (68.5%) presented with STEMI, and the remaining with non-STEMI (31.5%). Most vessels were functionally occluded (TIM1 flow grade </=1 in 67.1%). Thrombus burden was high (TIMI thrombus grade >/=4 in 77.2%). Aspiration thrombectomy was performed in 41% of cases. New stents were implanted in 62.4% cases. Intra-coronary imaging was low (11%). At the original stent implantation, STEMI was the clinical presentation in 39.6%, the lesion was complex in 62.1%, and thrombus was visualized in 23.0%. Prognosis after ST was unfavorable with high mortality (11.9% at 30days and 16.8% at one year), and further revascularization (5.0% repeat PCI and 6.9% coronary artery bypass graft surgery). Early ST was associated with worse clinical outcome compared to late/very late ST: 30-day mortality at 22.2% versus 6.2% (p=0.02), and 1-year mortality at 27.8% versus 10.8% (p=0.05). CONCLUSIONS: In this prospective registry from BC, all ST presented with myocardial infarction, and the majority was treated with emergency PCI. Additional stents were commonly implanted with infrequent use of intracoronary imaging. Mortality rate was higher for early ST in comparison with late/very late ST. A comprehensive approach should be developed to treat this difficult complication.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
LEMPEREUR, Mathieu ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Cardiologie interventionnelle
Claessen B.E., Henriques J.P., Jaffer F.A., Mehran R., Piek J.J., Dangas G.D. Stent thrombosis: a clinical perspective. J Am Coll Cardiol Intv 2014, 7:1081-1092.
Kirtane A.J., Gupta A., Iyengar S., Moses J.W., Leon M.B., Applegate R., et al. Safety and efficacy of drug-eluting and bare metal stents: comprehensive meta-analysis of randomized trials and observational studies. Circulation 2009, 119:3198-3206.
Lemesle G., De Labriolle A., Bonello L., Maluenda G., Torguson R., Xue Z., et al. Clinical manifestation and prognosis of early versus late stent thrombosis of drug-eluting stents. J Interv Cardiol 2009, 22:228-233.
de la Torre-Hernandez J.M., Alfonso F., Hernandez F., Elizaga J., Sanmartin M., Pinar E., et al. Drug-eluting stent thrombosis: results from the multicenter Spanish registry ESTROFA (Estudio ESpanol sobre TROmbosis de stents FArmacoactivos). J Am Coll Cardiol 2008, 51:986-990.
Iakovou I., Schmidt T., Bonizzoni E., Ge L., Sangiorgi G.M., Stankovic G., et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 2005, 293:2126-2130.
Daemen J., Wenaweser P., Tsuchida K., Abrecht L., Vaina S., Morger C., et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 2007, 369:667-678.
Rinaldi M.J., Kirtane A.J., Piana R.N., Caputo R.P., Gordon P.C., Lopez J.J., et al. Clinical, procedural, and pharmacologic correlates of acute and subacute stent thrombosis: results of a multicenter case-control study with 145 thrombosis events. Am Heart J 2008, 155:654-660.
Cutlip D.E., Windecker S., Mehran R., Boam A., Cohen D.J., van Es G.A., et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007, 115:2344-2351.
The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. TIMI Study Group. N Engl J Med 1985, 312:932-936.
Ryan T.J., Faxon D.P., Gunnar R.M., Kennedy J.W., King S.B., Loop F.D., et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1988, 78:486-502.
Huber M.S., Mooney J.F., Madison J., Mooney M.R. Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol 1991, 68:467-471.
McEntegart M.B., Kirtane A.J., Cristea E., Brener S., Mehran R., Fahy M., et al. Intraprocedural thrombotic events during percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes are associated with adverse outcomes: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol 2012, 59:1745-1751.
Levine G.N., Bates E.R., Blankenship J.C., Bailey S.R., Bittl J.A., Cercek B., et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011, 124:e574-e651.
Kimura T., Morimoto T., Kozuma K., Honda Y., Kume T., Aizawa T., et al. Comparisons of baseline demographics, clinical presentation, and long-term outcome among patients with early, late, and very late stent thrombosis of sirolimus-eluting stents: observations from the Registry of Stent Thrombosis for Review and Reevaluation (RESTART). Circulation 2010, 122:52-61.
Armstrong E.J., Feldman D.N., Wang T.Y., Kaltenbach L.A., Yeo K.K., Wong S.C., et al. Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. J Am Coll Cardiol Intv 2012, 5:131-140.
Mahmoud K.D., Vlaar P.J., van den Heuvel A.F., Hillege H.L., Zijlstra F., de Smet B.J. Usefulness of thrombus aspiration for the treatment of coronary stent thrombosis. Am J Cardiol 2011, 108:1721-1727.
Levine G.N., Bates E.R., Blankenship J.C., Bailey S.R., Bittl J.A., Cercek B., et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011, 58:e44-122.
Jolly S.S., Cairns J.A., Yusuf S., Meeks B., Pogue J., Rokoss M.J., et al. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 2015, 372:1389-1398.
Cook S., Wenaweser P., Togni M., Billinger M., Morger C., Seiler C., et al. Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation 2007, 115:2426-2434.
Ahn J.M., Kang S.J., Yoon S.H., Park H.W., Kang S.M., Lee J.Y., et al. Meta-analysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies. Am J Cardiol 2014, 113:1338-1347.
Zhang Y., Farooq V., Garcia-Garcia H.M., Bourantas C.V., Tian N., Dong S., et al. Comparison of intravascular ultrasound versus angiography-guided drug-eluting stent implantation: a meta-analysis of one randomised trial and ten observational studies involving 19,619 patients. EuroIntervention 2012, 8:855-865.
Sarno G., Lagerqvist B., Frobert O., Nilsson J., Olivecrona G., Omerovic E., et al. Lower risk of stent thrombosis and restenosis with unrestricted use of 'new-generation' drug-eluting stents: a report from the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur Heart J 2012, 33:606-613.
Sarno G., Lagerqvist B., Nilsson J., Frobert O., Hambraeus K., Varenhorst C., et al. Stent thrombosis in new-generation drug-eluting stents in patients with STEMI undergoing primary PCI: a report from SCAAR. J Am Coll Cardiol 2014, 64:16-24.
Sianos G., Papafaklis M.I., Daemen J., Vaina S., van Mieghem C.A., van Domburg R.T., et al. Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden. J Am Coll Cardiol 2007, 50:573-583.
Carrick D., Oldroyd K.G., McEntegart M., Haig C., Petrie M.C., Eteiba H., et al. A randomized trial of deferred stenting versus immediate stenting to prevent no- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI). J Am Coll Cardiol 2014, 63:2088-2098.
Secemsky E.A., Matteau A., Yeh R.W., Steg P.G., Camenzind E., Wijns W., et al. Comparison of short- and long-term cardiac mortality in early versus late stent thrombosis (from Pooled PROTECT Trials). Am J Cardiol 2015.
