Clinical presentation and predictors of Stent thrombosis after drug-eluting stent implantation for chronic coronary occlusions

Abstract

The objective of this study was to evaluate the incidence of stent thrombosis, as well as the clinical presentation and related factors in patients with chronic total coronary occlusions (CTO) treated with drug-eluting stents. Methods: The CIBELES (ChronIc coronary occlusion treated By EveroLimus Eluting Stent) trial allocated 207 patients with CTO to everolimus or sirolimus stent in 13 centers from Spain and Portugal. Stent thrombosis episodes accordingly to the Academic and Research Consortium (ARC) criteria were codified through a 12 month period. Results: During a 12 month follow-up, 3 episodes of definitive or probable stent thrombosis were diagnosed: 2 definitive thrombosis (1 and 117 days after the procedure), and 1 probable stent thrombosis (9 days after the procedure). Therefore, the incidence of definitive or probable stent thrombosis at 1 year was 1.4% (early stent thrombosis 0.9%, late stent thrombosis 0.5%). No death or Q-wave myocardial infarction occurred in these patients (clinical presentation was non-Q-wave acute myocardial infarction in 2, and unstable angina in 1 case). At univariate analysis, the risk of stent thrombosis was higher with left anterior descending coronary artery as treated vessel (3.5% vs 0.0%, p=0.037), single vessel disease (3.3% vs 0.0%, p=0.049), and treatment with sirolimus-eluting stent (3.,0% vs 0.0% in patients treated with everolimus-eluting stent, p=0.074). Patients with stent thrombosis had lower minimum lumen diamerer (1.3±0.6 mm vs. 2.6±0.5 mm, p<0.001), and higher % stenosis immediately after the procedure (43±14% vs 20±10%, p<0.001). At multivariate analysis, the only independent predictor of stent thrombosis was the minimum lumen diameter after the procedure. Conclusions: Incidence of definitive or probable stent thrombosis after drug-eluting stent implantation in CTO is low (1.5%), especially in patients treated with everolimus-eluting stents. The only independent predictor of stent thrombosis in these patients was minimum lumen diameter after stenting. Clinical presentation was relatively benign in all cases.