Frequency and correlates of coronary stent thrombosis in the modern era

Orford, James L.; Lennon, Ryan J.; Melby, Steven; Fasseas, Panayotis; Bell, Malcolm R.; Rihal, Charanjit S.; Holmes, David R.; Berger, Peter B.

doi:10.1016/s0735-1097(02)02374-4

Cited by 133 publications

(95 citation statements)

References 20 publications

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“…The variables that correlated with cardiac death at the 0.15 significance level comprised the full model. Such a significance level has previously been suggested (15). Two hundred bootstrap samples were selected; stepwise selection of variables was applied to each sample.…”

Section: Discussionmentioning

confidence: 99%

“…Two hundred bootstrap samples were selected; stepwise selection of variables was applied to each sample. The final model consisted only of variables selected in at least 140 (70%) of the bootstrap models, a cutoff value that has been used previously (15). Analyses were performed with SPSS software (version 17.0; SPSS Inc.) and STATA statistical software (release 11.0; StataCorp LP).…”

Section: Discussionmentioning

confidence: 99%

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Myocardial Perfusion Reserve After a PET-Driven Revascularization Procedure: A Strong Prognostic Factor

Slart

Zeebregts²,

Hillege

et al. 2011

J Nucl Med

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Not all patients treated on the basis of PET-proven viability benefit from revascularization. Myocardial perfusion reserve (MPR) predicts survival in patients not undergoing revascularization. In the present study, we investigated whether MPR is related to survival in ischemic heart disease (IHD) patients after a PET-driven intervention. Methods: Between 1995 and 2003, 119 consecutive patients with chronic IHD underwent a PETdriven revascularization procedure based on ischemia-viability assessment with PET. Patients were followed for all-cause mortality and major cardiovascular events. Results: One hundred nineteen patients underwent a PET-driven revascularization procedure (67 percutaneous coronary interventions, 52 coronary artery bypass grafts) because of angina complaints. The mean age was 67 6 11 y (96 men, 23 women); global left ventricle MPR was 1.54 6 0.43. MPR intertertile boundaries were 1.34 and 1.67. Significantly more cardiac deaths were observed in the lowest and middle MPR tertiles than in the highest tertile. The age-and sex-corrected hazard ratio for the middle tertile was 8.3 (95% confidence interval, 1.02-68.3) and for the lowest tertile 23.6 (95% confidence interval, 3.1-179) (P 5 0.002). After left ventricular ejection fraction (LVEF) and viability were added to the model, MPR remained significant, with hazard ratios of 6.5 (0.8-54.4) and 18.5 (2.32145.5) (P 5 0.004), whereas neither LVEF nor viability reached significance in this model. Comparable results were found for major adverse cardiac events, with hazard ratios of 3.15 (0.82-12.0) and 8.24 (2.36-28.8) (P 5 0.002). Conclusion: Patients with IHD revascularized on the basis of PET viability assessment who have a low MPR are at risk for cardiac death and subsequent cardiac events. MPR is a more sensitive predictor for cardiac death than LVEF and extent of viability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Myocardial Perfusion Reserve After a PET-Driven Revascularization Procedure: A Strong Prognostic Factor

Slart

Zeebregts²,

Hillege

et al. 2011

J Nucl Med

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“…24) However, late stent thromboses occur a month after BMS implantation. 23,25) These facts suggest that part of the struts of BMSs would still be exposed into the vessel lumen without complete endothelialization for more than a month. The current angioscopic study may be helpful to explain these differences in the time course of neointimal proliferation over the stent.…”

Section: Discussionmentioning

confidence: 99%

Difference in Neointimal Proliferation Between Ruptured and Non-Ruptured Segments After Bare Metal Stent Implantation

et al. 2010

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SummaryThe difference in neointimal stent coverage (NSC) between ruptured segments and adjacent nonruptured segments in infarct-related lesions (IRL) of acute myocardial infarction after bare metal stent (BMS) implantation was evaluated using coronary angioscopy. Serial angioscopic observations were performed for 19 IRLs immediately after the implantation of a BMS and at 1-month and 6-month follow-up. Stented segments were divided into the ruptured segment and the nonruptured segment based on the presence of a thrombus. The grade of NSC was divided into 0 = complete exposure, 1 = partial coverage, or 2 = complete coverage. The grade of plaque color was classified semiquantitatively as 0 = white, 1 = light yellow, or 2 = intense yellow. The existence of a thrombus was also determined. The grade of NSC in the ruptured segment was lower than that of the nonruptured segment at each follow-up. The grade of plaque color at the 1-month follow-up was higher in the ruptured segment than in the nonruptured segment. At 6 months, the grade of plaque color was similar between the ruptured and nonruptured segments. In all cases, thrombi existed in the ruptured segments immediately after stenting. Although thrombi still remained frequently at 1-month, most had disappeared at the 6-month follow-up. Neointimal proliferation of the ruptured segment in IRL advanced slowly in comparison to the adjacent nonruptured segment. The presence of an atherosclerotic yellow plaque and a thrombus may affect the delayed neointimal coverage after BMS implantation. (Int Heart J 2010; 51: 7-12) Key words: Acute myocardial infarction, Stent, Neointima, Plaque R ecently, a late thrombosis after stent implantation has emerged as a major clinical concern regardless of the type of stent, such as a bare metal stent (BMS) or a drug-eluting stent, because it is a life-threatening complication.1-3) The principal mechanisms of the late stent thrombosis are delayed endothelialization, lack of neointimal stent coverage (NSC), and the presence of persistent uncovered stent struts. 4,5) Several follow-up studies after stent implantation using coronary angioscopy demonstrated that NSC had an effect on plaque stabilization due to the complete sealing of the stent by the neointima underlying the ruptured plaque regardless of any unstable clinical settings, such as an acute myocardial infarction (AMI). 6,7)Moreover, NSC after stent implantation has a different time course between patients with an AMI and those with stable angina pectoris. 7,8) The major causes of an AMI are understood to be the disruption of atherosclerotic vulnerable plaques and subsequent thrombus formation and a vulnerable plaque is recognized as yellow by coronary angioscopy.9-11) Although a coronary stent is deployed on the ruptured segment, the location of the stent extends to the nonruptured segment beyond the ruptured segment. Angioscopic plaque morphology between the ruptured and nonruptured segments is quite different. The ruptured segment is defined as the site of a vulnerable yellow pl...

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“…Stent thrombosis although rare is a catastrophic complication of percutaneous coronary interventions (PCI) with mortality up to 40% [1][2][3][4][5][6]. It is believed that acute stent thrombosis that occurs within 24 h from stent implantation is mostly related to procedural factors, i.e.…”

Section: Introductionmentioning

confidence: 99%

Relation of subacute stent thrombosis and resistance to acetylsalicylic acid and clopidogrel in patients with acute coronary syndrome. Insights from the ANIN Myocardial Infarction Registry

Pręgowski¹,

Przyłuski²,

Karcz³

et al. 2010

pwki

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A b s t r a c t Background: Stent thrombosis (ST) is a catastrophic complication of percutaneous coronary interventions (PCI).Aim: To assess the relation between subacute ST and response to antiplatelet treatment in patients with acute coronary syndrome (ACS) and to check the effect of doubling the maintenance dose of clopidogrel on platelet response.Material and methods: We performed a retrospective search of the prospective single-centre ANIN Myocardial Infarction Registry and enrolled 22 patients with a history of subacute ST following PCI for ACS and 36 matched control subjects. Platelet aggregation was assessed at baseline under monotherapy with acetylsalicylic acid (ASA) 75 mg and after 7 days of dual therapy with ASA and clopidogrel 75 mg daily. Platelet function was evaluated with light transmittance aggregometry after addition of an agonist: epinephrine (30 µmol/l) or adenosine 5'-diphosphate (ADP) (5 µmol/l). Patients in whom clopidogrel resistance was identified were administered a maintenance dose of 150 mg and after 7 days platelet aggregation was assessed again.Results: Maximal epinephrine-induced aggregation in patients on ASA who developed ST and in control subjects was similar (48.9 ±28.3% vs. 46.9 ±29.9%, p = 0.8). After 7 days of clopidogrel treatment no significant difference in the extent of aggregation was detected between the study groups (58.7 ±21.3% vs. 66.0 ±17.7%, p = 0.2). According to the binary definition 14% of patients were resistant to ASA in the ST group and 29% of patients in the control group (p = 0.7). Also there was no difference in the incidence of clopidogrel resistance (57% vs. 48%, p = 0.4 respectively). In 13 patients resistant to clopidogrel a dual maintenance dose (150 mg daily) resulted in significant reduction of maximal ADP-induced aggregation after 7 days (73.6 ±16.7% vs. 60.2 ±11.3%, p = 0.037) Conclusions: Clinical and angiographic variables other than laboratory identified platelet resistance to ASA and clopidogrel may play a more important role in the development of subacute stent thrombosis in patients treated with PCI for ACS. Doubling the maintenance dose of clopidogrel may reduce the incidence of platelet resistance.Key words: stent thrombosis, platelet resistance to ASA and clopidogrel S t r e s z c z e n i e Wstęp: Zakrzepica w stencie (ZS) stanowi jedno z najcięższych powikłań kardiologii interwencyjnej. Cel: Ocena związku pomiędzy odpowiedzią płytek krwi na kwas acetylosalicylowy (ASA) i klopidogrel a wystąpieniem podostrej ZS u chorych z wywiadem ostrego zespołu wieńcowego (OZW) oraz sprawdzenie wpływu podwojenia dawki podtrzymującej klopidogrelu na odpowiedź płytek.

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Frequency and correlates of coronary stent thrombosis in the modern era

Abstract: Stent thrombosis is even more rare in the current era than in earlier trials. Number of stents placed was an independent correlate of stent thrombosis. Most patients who suffer stent thrombosis either die or suffer MI.

Cited by 133 publications

References 20 publications

Myocardial Perfusion Reserve After a PET-Driven Revascularization Procedure: A Strong Prognostic Factor

Myocardial Perfusion Reserve After a PET-Driven Revascularization Procedure: A Strong Prognostic Factor

Difference in Neointimal Proliferation Between Ruptured and Non-Ruptured Segments After Bare Metal Stent Implantation

Relation of subacute stent thrombosis and resistance to acetylsalicylic acid and clopidogrel in patients with acute coronary syndrome. Insights from the ANIN Myocardial Infarction Registry

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