Drug-Eluting Stent Thrombosis in Routine Clinical Practice

Abstract

for the ARRIVE 1 and ARRIVE 2 Participating Physicians Background-Stent thrombosis (ST) is an uncommon but serious complication of drug-eluting and bare metal stents.To assess drug-eluting stent ST in contemporary practice, we analyzed 2-year data from the 7492-patient ARRIVE registry. Methods and Results-Patients were enrolled at the initiation of percutaneous coronary intervention with no inclusion/ exclusion criteria beyond use of the paclitaxel-eluting TAXUS stent. Two-year follow-up was 94% with independent adjudication of major cardiac events.

Prognostic Implications of Chronic Kidney Disease on Patients Presenting with ST-Segment Elevation Myocardial Infarction with versus without Stent Thrombosis

“…Still, a survival bias may have occurred because out-of-hospital deaths as a result of ST were not included in our cohort. Second, as ST is an uncommon complication of PCI, our ST group of 83 patients (4.8% of the entire study population) is consistent with previous reports [8,9,10], and thus could be underpowered to detect differences between the ST subgroups. Third, only serum creatinine level at admission was used to assess basic renal function as previously done [6,7], which might be a source of error as the MDRD equation requires a stable creatinine level which might not be the case in STEMI patients.…”

“…In previous reports, CKD was an independent risk factor for ST [9,10,11,12,13]. Breet et al [14] reported a higher rate of on-clopidogrel and on-aspirin platelet reactivity in patients with eGFR <60 mL/min/1.73 m 2 compared with those with higher eGFR.…”

“…These observations are contrary to a previous report [17] and may have some important clinical implications. CKD patients comprise a high-risk group among PCI-treated patients with a greater tendency for both bleeding [25] and thrombosis [9,10,11,12,13]. Thus, among patients who survived an ST event, those with CKD, despite a higher risk for bleeding [25], may still require more intense long-term clinical follow-up, possibly in conjugation with platelet function testing.…”

“…Among patients with myocardial infarction treated with percutaneous coronary intervention (PCI), CKD is a well-established predictor for in-hospital complications and mortality as well as for long-term mortality [4,5,6,7]. Stent thrombosis (ST) is a dreaded complication of PCI associated with high morbidity and mortality [8,9,10]. CKD was implicated as a risk factor for ST by various investigators [9,10,11,12,13] with an observed higher magnitude of on-treatment platelet reactivity among CKD patients cited as a possible mechanism for this interaction [14,15].…”

“…Stent thrombosis (ST) is a dreaded complication of PCI associated with high morbidity and mortality [8,9,10]. CKD was implicated as a risk factor for ST by various investigators [9,10,11,12,13] with an observed higher magnitude of on-treatment platelet reactivity among CKD patients cited as a possible mechanism for this interaction [14,15]. Very few reports, however, evaluated the possible impact of CKD on the prognosis of patients who suffered an ST event and those who did produced conflicting results [16,17].…”