Abstract 37: Short-Term Clinical and Economic Consequences of Coronary Stent Thrombosis

Abstract

Objective: To conduct a systematic review and meta-analysis to better quantify the real-world incidence of in-hospital or 30-day death or myocardial infarction (MI) following coronary stent thrombosis (ST), as well as ST-related treatment costs. Methods: We searched Medline, Embase and Scopus from January 2000-July 2012 to identify observational or registry studies that evaluated a cohort of ≥25 patients experiencing angiographically-confirmed thrombosis of a drug-eluting or bare-metal stent, required the use of dual-antiplatelet therapy for guideline recommended durations, and reported on the incidence of in-hospital or 30-day death or MI and/or ST-related treatment costs. Incidences and treatment costs from each study were pooled using random-effects meta-analysis. Statistical heterogeneity was assessed using the I2 statistic (>50% deemed significant). Results: A total of 23 studies were included. Among the 12 studies (N=8,832 STs) reporting in-hospital mortality, the pooled incidence rate was estimated to be 7.9%, 95%CI=5.4%-11.3%, I2=86%. Ten studies (N=1,294 STs) reported 30-day death, with a pooled incidence of 11.6%, 95%CI=8.8%-15.1%, I2=55%. Subgroup analysis suggested patients experiencing early ST (within 30-days of implant) had higher in-hospital and 30-day mortality than those experiencing very-late ST (interaction p<0.04 for both). Stent type (bare-metal vs. drug-eluting) had no significant effect on in-hospital or 30-day mortality (interaction p>0.22 for both). In the 5 studies (N=542 STs) and 3 studies (N=180 STs) reporting in-hospital and 30-day MI, respectively, the pooled incidence rates were 6.1%, 95%CI=2.1%-16.2%, I2=88% and 9.5%, 95%CI=3.8%-22.0%, I2=65%. Only one study reported costs associated with ST, estimating the median/patient cost of hospitalization to treat early ST at $11,134 (in 2000US$). Because of the small number of studies identified, no additional analyses were performed on the MI or the ST-treatment cost endpoints. Conclusions: Regardless of stent type used, the short-term clinical and economic consequences of coronary stent thrombosis (ST) appear significant. While stent type does not seem to affect the incidence of post-ST outcomes, an earlier occurrence of ST may be associated with higher mortality.