Independent Predictor Of Stent Thrombosis Research Articles

Efekti kliničkih, laboratorijskih i angiografskih faktora na trombozu stenta i neželjeni kardiovaskularni događaji u stentovima obloženim paklitakselom

Background: Drug-eluting stents (DES) have higher marked efficacy and lower revascularization requirements compared to bare metal stents (BMS).We aimed to determine the mid-term outcomes of patients implanted with a first-generation DES "paclitaxel-eluting stents" (PES). Methods: Patients with at least 1 PES implanted in our cardiology clinic were received in the non-randomized group. Inclusion criteria were all patients undergoing percutaneous coronary intervention and PES implantation. The mean follow-up time was 35.14 + 13.4 months. Results: A total of 302 patients (401 lesions and 337 PES) were enrolled in the study. The mean age was 61.86 + 10.27 years. Major adverse cardiac and cerebrovascular events (MACE) occurred at 17.9%, and the stent thrombosis rate was 4%. Independent predictors of stent thrombosis were serum creatinine levels [OR 1.59; 95% CI, 1.03-2.46, p = 0.03] and mean platelet volume [OR 1.59; 95% CI, 1.03-2.46, p = 0.03]. Also, poor functional capacity [OR 2.46: 95% CI, 1.42-4.26, p < 0.001] and positive ischemia test [OR 3.43: 95% CI, (1.73-6.82), p < 0.001] were predictors of MACE's. Conclusions: We have demonstrated that PES is safe and effective in the mid-term for use in coronary artery disease

Timing and predictors of definite stent thrombosis in comatose survivors of out-of-hospital cardiac arrest undergoing percutaneous coronary intervention and therapeutic hypothermia (ST-OHCA study).

Incidence of stent thrombosis (ST) in comatose survivors of out-of-hospital cardiac arrest (OHCA) undergoing immediate percutaneous coronary intervention (PCI) and therapeutic hypothermia (TH) varies considerably, from 2.7% to 31.2%, in retrospective studies. We aimed to investigate occurrence, timing and predictors of definite ST. We prospectively investigated consecutive comatose survivors of OHCA with presumed cardiac aetiology undergoing immediate PCI with drug-eluting stents (DES) and TH targeted at 32-34°C admitted between August 2016 and July 2021. Repeat coronary angiography (CAG) was performed if ST was suspected and systematically between day 8-12 in the absence of clinical signs. All deceased patients underwent autopsy and histopathological analysis. Results: Among 362 comatose survivors of OHCA, immediate PCI with stenting was performed in 169 patients (47%). Since 18 patients did not complete follow-up, 151 patients were ultimately enrolled in ST analysis. Definite ST was confirmed in 29 patients (19.2%; 95% confidence interval [CI]: 12.9%-25.6%) either by CAG (n=18) or autopsy (n=11). ST occurred within 3 days in 62% and presented with at least one clinical sign in 79%. Survival with good neurological recovery was observed in 17% of patients with ST and in 60% of patients without ST (p<0.001). Independent predictors of ST were longer prehospital resuscitation, lower arterial pH and increased creatinine on admission. The incidence of definite ST in comatose survivors of OHCA undergoing immediate PCI and TH targeted at 32-34°C is substantial (19.2%) and significantly higher than in other PCI subsets despite systematic use of contemporary DES and anticoagulation/antiplatelet treatment.

ASSOCIATION OF GENDER WITH STENT THROMBOSIS AND SHORT-TERM MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Objectives: Gender has been reported to be an independent predictor of stent thrombosis (ST), however, very limited data are available regarding gender disparities in the incidence of ST after primary percutaneous coronary intervention (PCI). Therefore, the objective of this study was to compare the incidence of ST among males and females after primary PCI. Methodology: In this study, we included consecutive patients diagnosed with ST-elevation myocardial infarction undergoing primary PCI. The incidence of ST and short-term major adverse cardiovascular events (MACE) were compared between male and female cohorts. Results: The gender distribution was 21% (368) female and 79% (1388) male patients. In the unmatched cohorts of females and males, the incidence of ST was 3.3% (12) vs. 5.3% (74); p=0.102, respectively. Short-term all-cause mortality rate was 12.2% (45) vs. 8.6% (119); p=0.032 among female and male patients, respectively. After propensity matching of the baseline characteristics, the incidence of stent thrombosis was 3.3% (12) vs. 4.9% (18); p=0.263 among females and male counterparts, respectively. The short-term all-cause mortality rate was 12.2% (45) vs. 10.6% (39); p=0.487 among female and propensity-matched male cohorts, respectively. Conclusion: There are no gender-based disparities in the incidence of ST as well as short-term MACE after primary PCI. The gender of the patient itself does not determine the prognosis of the patient, but longer ischemic time, older age, and consequently higher burden of risk factors confound the effect of the female gender.

Incidence, Predictors, and Outcomes of Acute and Sub-acute Stent Thrombosis after Emergency Percutaneous Coronary Revascularization with Drug-Eluting Stents: A Prospective Observational Study.

Background:Stent thrombosis (ST) remains the most feared complication of percutaneous coronary intervention (PCI). Therefore, this study aimed to determine acute and sub-acute ST incidence, predictors, and outcomes after primary PCI.Methods:This prospective observational study included patients who had undergone primary PCI at a tertiary care cardiac center. All the patients were followed at 30-days of index hospitalization for the incidence of acute or sub-acute ST. ST was further categorized as definite, probable, or possible per the Academic Research Consortium definition. All the survivors of ST were followed after 6-months for the incidence of major adverse cardiovascular events.Results:An aggregate of 1756 patients were included with 79% (1388) male patients and mean age was 55.59 ± 11.23 years. The incidence of ST was 4.9% (86) with 1.3% (22) acute and 3.6% (64) sub-acute. ST was categorized as definite in 3.3% (58) and probable in 1.6% (28). Independent predictor of ST were observed to be male gender (odds ratio (OR); 2.51 [1.21–5.2]), left ventricular end-diastolic pressure ≥20 mmHg (OR; 2.55 [1.31–4.98]), and pre-procedure thrombolysis in myocardial infarction (TIMI) flow 0 (OR; 3.27 [1.61–6.65]). Cumulative all-cause mortality among patients with ST after 164.1 ± 76.2 days was 46.5% (40/86).Conclusion:We observed a substantial number of patients vulnerable to the acute or sub-acute ST after primary PCI. Male gender, LVEDP, pre-procedure TIMI flow grade can be used to identify and efficiently manage highly vulnerable patients.

Elevated Serum Levels of Alkaline Phosphatase and the Risk of Low Responsiveness to Clopidogrel.

The elevated serum levels of alkaline phosphatase (ALP) serve as independent predictors of stent thrombosis after percutaneous coronary intervention (PCI). Our study aims at investigating the relationship between the serum ALP and the responsiveness to clopidogrel. Patients undergoing elective PCI were enrolled for the study, and all participants received a 300-mg clopidogrel loading dose. The responsiveness to clopidogrel was determined by thromboelastography (TEG), and low responsiveness to clopidogrel was defined based on two aspects: (1) adenosine diphosphate (ADP) -induced platelet-fibrin clot strength (MAADP) of > 47 mm and (2) ADP-induced platelet inhibition rate of < 50%. A logistic regression model analysis was used to calculate the risks of responsiveness to clopidogrel as odd ratios (OR) and 95% confidence intervals (CIs). Overall, 809 patients were considered for the study. They were divided into four quartile groups based on the serum ALP levels. A positive linear trend was observed in MAADP across the ALP quartiles (P for linear trend < 0.001), whereas ADP-induced platelet inhibition rate decreased across the ALP quartiles (P for linear trend = 0.007). When multiple confounders were adjusted, the highest ALP quartile correlated with an increased risk of low responsiveness to clopidogrel compared to the lowest ALP quartile (OR, 1.423; 95% CI, 1.017-1.991; P = 0.039). In the sensitivity analysis, the association remained significant for different definitions of low responsiveness to clopidogrel. The elevated serum levels of ALP are independently associated with an increased risk of low responsiveness to clopidogrel.

Long-term outcomes after bioresorbable scaffold implantation in patients with coronary artery stenosis

Aim. The present study aimed to demonstrate the long-term outcomes after Absorb (Abbott Vascular, USA) everolimus-eluting bioresorbable vascular scaffold (BVS) implantation in real-world patients with coronary artery disease.Methods. This trial involved the largest registry of Absorb BVS implantation in patients with coronary artery disease from Russia, and it was conducted between 2014 and 2018 (n = 500). Safety and efficacy parameters (target vessel failure, defined as a composite of cardiac death, target vessel myocardial infarction and clinically driven target vessel revascularisation; major adverse cardiac and cardiovascular events, defined as a composite of cardiac death, myocardial infarction, target vessel revascularisation and stroke, stent thrombosis according to the Academic Research Consortium definition) were assessed over a period of 2 years after the index procedure. Results. Lesion treatment success was achieved in 98.51% (n = 594) of patients. In the 2 years after Absorb BVS implantation, long-term outcomes were assessed via phone calls. Only 9.8% (n = 49) of patients were lost to follow-up. The rates of target vessel failure and major adverse cardiac and cerebrovascular events were 11.6% (n = 58) and 12.6% (n = 63), respectively. Definite/probable stent thrombosis was observed in 3.2% (n = 16) of patients. Conclusion. Using an optimal implantation technique during Absorb BVS implantation in routine clinical practice leads to a high level of lesion treatment success. However, despite this, Absorb BVS use is associated with an increased risk of device-related adverse events, particularly stent thrombosis. Absorb BVS use in long and bifurcated lesions and BVS implantation in the distal segment of the coronary artery are independent predictors of stent thrombosis. In addition, Absorb BVS use in patients with a high functional class of angina and heart failure, multivessel coronary artery disease as well as BVS implantation in the distal segment of the coronary artery are independent predictors of device-related adverse events.Received 22 July 2019. Revised 1 October 2019. Accepted 14 October 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

A simple score for the prediction of stent thrombosis in patients with ST elevation myocardial infarction: TIMI risk index.

Introduction: The present study aimed to evaluate the potential utility of thrombosis in myocardial infarction (TIMI) risk index (TRI) for the prediction of stent thrombosis (ST) in ST elevation myocardial infarction (STEMI) patients who were treated with primary percutaneous coronary intervention ( pPCI ). Methods: This retrospective study was related to the clinical data of 1275 consecutive STEMI patients who underwent pPCI from January 2013 to January 2018. The TRI was calculated for each patient, and the following equation was used; TRI = heart rate x [age/10]2/systolic blood pressure. For the definition of ST, the criteria as proposed by the Academic Research Consortium were applied. Results: The incidence of ST was 3.2% (n=42 patients) in the study. The median value of the TRI was significantly elevated in patients with ST compared to those without ST (22 [17-32] vs. 16 [11-21], P<0.001, respectively). In a multivariate logistic regression analysis, the TRI was an independent predictor of ST (odds ratio [OR]: 1.061; 95% CI: 1.038-1.085; P<0.001). In a receiver operating characteristic curve analysis, the optimal value of the TRI for the prediction of ST was 25.8 with a sensitivity of 45.2% and a specificity of 86.4%. Conclusion: The present study finding has demonstrated that the TRI may be an independent predictor of ST in STEMI patients who were treated with pPCI . To the best of our knowledge, this is the first study in the literature in which the TRI and its relationship with ST was evaluated in STEMI patients treated with pPCI .

Impact of direct stenting on clinical outcomes for small vessel coronary artery disease in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.

IntroductionDirect stenting (DS) is associated with improved markers of reperfusion during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). However, data evaluating its impact in small vessel coronary artery disease (CAD) are lacking.AimTo compare DS and conventional stenting (CS) for small vessel CAD on clinical outcomes of patients with STEMI undergoing PPCI.Material and methodsA cohort of 616 STEMI patients treated with DS (202 patients) or CS (414 patients) in small vessel (≤ 2.75 mm) lesions was retrospectively analyzed. The primary endpoint was to compare the occurrence of major adverse cardiac events (MACE) between groups during 2-year follow-up. The secondary end points included in-hospital target lesion revascularization (TLR) and in-hospital death.ResultsThe primary end-point, MACEs, occurred in 9.2% in the DS group and 12.3% in the CS group (p > 0.05). The rates of TLR, myocardial infarction (MI) and target vessel revascularization (TVR) were not significantly different between groups (p > 0.05). The stent thrombosis (ST) rate was significantly lower in the DS group (1.0% vs. 4.2%, p = 0.04) at 2 years. However, DS was not found to be an independent predictor of ST in multivariate analysis. There were no significant differences in in-hospital rates of death and TLR. The DS compared to CS resulted in greater rates of postprocedural TIMI grade 3 flow, and lower risk of edge dissection. The procedure time, radiation exposure and contrast administration were found to be significantly lower in the DS group.ConclusionsIn selected patients with STEMI undergoing PPCI for small vessel CAD, DS is not only safe and feasible but also reduces ST rates, contrast load, and procedural and radiation exposure time.

Annual Incidence of Confirmed Stent Thrombosis and Clinical Predictors in Patients With ACS Treated With Ticagrelor or Prasugrel

Introduction and objectivesThere is little evidence on rates of stent thrombosis (ST) in patients receiving dual antiplatelet therapy (DAPT) with ticagrelor or prasugrel. The aim of this study was to analyze the incidence and predictors of ST after an acute coronary syndrome among patients receiving DAPT with ticagrelor vs prasugrel. MethodsWe used data from the RENAMI registry (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction), analyzing a total of 4123 acute coronary syndrome patients discharged with DAPT with ticagrelor or prasugrel in 11 centers in 6 European countries. The endpoint was definite ST within the first year. A competitive risk analysis was carried out using a Fine and Gray regression model, with death being the competitive event. ResultsA total of 2604 patients received DAPT with ticagrelor and 1519 with prasugrel; ST occurred in 41 patients (1.10%), with a similar cumulative incidence between ticagrelor (1.21%) and prasugrel (0.90%). The independent predictors of ST were age (sHR, 1.03; 95%CI, 1.01-1.06), ST segment elevation (sHR, 2.24; 95%CI, 1.22-4.14), previous myocardial infarction (sHR, 2.56; 95%CI, 1.19-5.49), and serum creatinine (sHR, 1.29; 95%CI, 1.08-1.54). ConclusionsStent thrombosis is infrequent in patients receiving DAPT with ticagrelor or prasugrel. The variables associated with an increased risk of ST were advanced age, ST segment elevation, previous myocardial infarction, and serum creatinine.

Incidencia anual de trombosis del stent confirmadas y factores clínicos predictores en pacientes con SCA tratados con ticagrelor o prasugrel

Introduction and objectivesThere is little evidence on rates of stent thrombosis (ST) in patients receiving dual antiplatelet therapy (DAPT) with ticagrelor or prasugrel. The aim of this study was to analyze the incidence and predictors of ST after an acute coronary syndrome among patients receiving DAPT with ticagrelor vs prasugrel. MethodsWe used data from the RENAMI registry (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction), analyzing a total of 4123 acute coronary syndrome patients discharged with DAPT with ticagrelor or prasugrel in 11 centers in 6 European countries. The endpoint was definite ST within the first year. A competitive risk analysis was carried out using a Fine and Gray regression model, with death being the competitive event. ResultsA total of 2604 patients received DAPT with ticagrelor and 1519 with prasugrel; ST occurred in 41 patients (1.10%), with a similar cumulative incidence between ticagrelor (1.21%) and prasugrel (0.90%). The independent predictors of ST were age (sHR, 1.03; 95%CI, 1.01-1.06), ST segment elevation (sHR, 2.24; 95%CI, 1.22-4.14), previous myocardial infarction (sHR, 2.56; 95%CI, 1.19-5.49), and serum creatinine (sHR, 1.29; 95%CI, 1.08-1.54). ConclusionsStent thrombosis is infrequent in patients receiving DAPT with ticagrelor or prasugrel. The variables associated with an increased risk of ST were advanced age, ST segment elevation, previous myocardial infarction, and serum creatinine.Full English text available from: www.revespcardiol.org/en

Incidence, determinants and clinical impact of definite stent thrombosis on mortality in women: From the WIN-DES collaborative patient-level pooled analysis

BackgroundPredictors and clinical outcomes of stent thrombosis (ST) in women have not been well investigated. Present study aimed to identify predictors of definite ST and its impact on mortality in women undergoing percutaneous coronary intervention (PCI). MethodsPatient-level data of women enrolled in 26 randomized trials of DES was pooled. The study population was stratified based on the presence or absence of definite ST. Cox proportional hazards models were used to determine the predictors of definite ST. To analyze the temporal impact of definite ST on mortality Cox regression with ST entered as time-updated covariate was used. ResultsOf 11,557 patients undergoing PCI with stent implantation, definite ST occurred in 105 patients (0.9%) over median follow-up of 3years. Independent predictors of ST were age (HR 1.03 per year decrease, 95% CI 1.00–1.05; p=0.041), diabetes mellitus (HR 2.25, 95% CI 1.27–3.99; p=0.005), non-ST-segment elevation myocardial infarction (NSTEMI) at presentation (HR 1.97, 95% CI 1.04–3.75; p=0.037) and stent diameter (HR 3.76 per mm decrease, 95% CI 1.66–8.53; p=0.002).Compared to women without ST, the adjusted hazard ratios for mortality in the first 7days, 8–30days, and beyond 30days from ST were 115.81 (95% CI 68.96–194.47); 37.44 (95% CI 17.31–80.98); 3.54 (95% CI 2.20–5.69), respectively. ConclusionsIn this large-scale pooled analysis of women, definite ST was uncommon yet associated with substantial mortality risk, which peaked early and rapidly attenuated over time. Younger age, diabetes, NSTEMI and stent diameter were found to be predictors of ST.

Association between RDW and stent thrombosis in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Stent thrombosis is a rare but potentially fatal complication of percutaneous coronary interventions (PCIs). In recent years, the predictive and prognostic value of the red cell distribution width (RDW) as an indicator of inflammation has been shown in many cardiovascular diseases. Aim of this study was to examine the predictive value of RDW for stent thrombosis in patients who underwent successful stent implantation for ST-elevation myocardial infarction (STEMI).In this retrospective study, 146 patients who underwent successful PCI to native coronary artery due to STEMI previously and presented with acute coronary syndrome with stent thrombosis were included (stent thrombosis group). A total of 175 patients who had similar procedural characteristics (type, diameter, and length of stent) and not had stent thrombosis were consisted control group.Patients were divided into tertiles according to the admission RDW values (12.9 ± 0.4, 14.2 ± 0.4, and 16.3 ± 1.5, respectively). Stent thrombosis developed in 47 (40.9%) patients in the lowest tertile, 39 (37.9%) patients in mid tertile, and 60 (58.3%) patients in the highest tertile (P = 0.006). Female gender ratio was statistically significantly higher in the 3rd tertile (13 [11.3%], 8 [7.8%], 24 [23.3%], P = 0.003, respectively). RDW (OR: 1.397 [95% CI 1.177–1.657], P < 0.001) and platelet count (OR: 1.008 [95% CI 1.004–1.012], P < 0.001) remained independent predictors of stent thrombosis after multivariate logistic regression analysis. ROC curve analysis demonstrated that, admission RDW values higher than 13.9 can predict the development of stent thrombosis with a sensitivity of 57% and a specificity of 52% (The area under the ROC curve: 0.59 [95% CI 0.53–0.65] P = 0.007).High RDW values found to be independently associated with the development of stent thrombosis in patients with STEMI.

Incidence, Implications, and Predictors of Stent Thrombosis in Acute Myocardial Infarction

Stent thrombosis (ST) remains a catastrophic problem in patients undergoing percutaneous coronary intervention (PCI). However, a paucity of data exist regarding the incidence, implications, and predictors of ST in patients with acute myocardial infarction (AMI). We consecutively enrolled patients with AMI in the CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI registry who underwent PCI from January 2004 to December 2009 and analyzed definite or probable ST according to Academic Research Consortium definitions. The median follow-up duration was 41.9months. Definite or probable ST occurred in 136 patients (3.7%), including 44 with early ST (1.0%), 38 with late ST (0.9%), and 54 with very late ST (2.0%). The annual incidence of very late ST ranged from 0.5% to 0.6%. The all-cause mortality rate after ST was 29%, which was higher than that for patients without ST (17%; p <0.001). The independent predictors of ST were no-reflow phenomenon (hazard ratio [HR] 1.96, 95% confidence interval [CI] 1.28 to 3.03), decreased left ventricular ejection fraction (HR 1.70, 95% CI 1.21 to 2.40), anemia (HR 1.54, 95% CI 1.09 to 2.18), and a mean stent diameter <3.0mm (HR 1.53, 95% CI 1.04 to 2.27). ST is not uncommon in patients with AMI and continues to occur beyond 1year after PCI, irrespective of the stent type or clinical presentation. Patients with ST are associated with higher mortality than patients without ST. No reflow, decreased left ventricular ejection fraction, anemia, and a mean stent diameter <3.0mm are independent predictors of ST.

Prior chronic clopidogrel therapy is associated with increased adverse events and early stent thrombosis.

Despite the growing use of clopidogrel, limited data exist regarding the prognostic significance of chronic clopidogrel therapy in patients sustaining acute coronary syndrome (ACS). Our aim was to determine whether patients sustaining ACS while on chronic clopidogrel therapy have a worse prognosis than clopidogrel-naïve patients. A total of 5,386 consecutive ACS patients were prospectively characterised and followed-up for 30 days. Of them, 680 (13%) were treated with clopidogrel prior to the index ACS. Major adverse cardiovascular events (MACE) were defined as death, recurrent ACS, stroke and/or stent thrombosis. Compared with clopidogrel-naïve, chronic clopidogrel-treated patients were older (66 ± 12 vs 63 ± 13, respectively; p<0.01), suffered more from diabetes mellitus, hypertension, dyslipidaemia, prior cardiovascular history, including prior myocardial infarction, revascularisation, coronary artery bypass graft and stroke (p<0.01 for all), and were less likely to present with ST-elevation myocardial infarction (21% vs 45%; respectively; p < 0.001). Prior clopidogrel therapy was associated with a two-fold increase in in-hospital (1.6% vs 0.6%, respectively; p =0.006) as well as 30-day stent thrombosis (2.2% vs 1.0%, respectively; p=0.007). MACE at 30 days was also higher among chronic clopidogrel-treated compared with clopidogrel-naïve patients [12.3% vs 9.4%, respectively; p<0.01]. In multivariate log regression analysis chronic clopidogrel treatment was an independent predictor of stent thrombosis [OR=2.6 (95%CI 1.2-5.6), p=0.001]. Patients sustaining ACS while on chronic clopidogrel treatment are at higher risk for in-hospital and 30-day adverse outcomes, including stent thrombosis.

Monocyte/HDL-cholesterol ratio predicts the definite stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

We investigated the predictive value of monocyte count to HDL ratio (M/H ratio) for stent thrombosis (ST) in ST elevation myocardial infarction (STEMI). 1170 STEMI patients treated with primary PCI were followed-up for a median of 37.2 months. During follow-up, 112 patients were diagnosed as 'definite' ST. The rate of ST was significantly highest in the third M/H ratio tertile. In Cox regression analysis, adjusted for other factors, having an M/H ratio in third tertile had a 2.2-fold increased risk of ST. Kaplan-Meier analysis revealed the higher occurrence of ST in the third tertile compared with others (p <0.001). M/H ratio as a novel marker of inflammation seemed to be an independent predictor of ST in STEMI patients.

Drug-eluting stent thrombosis in the treatment of chronic total coronary occlusions: Incidence, presentation and related factors. Data from the CIBELES trial

Introduction and ObjectivesThe aim of this study was to analyze the incidence of drug-eluting stent thrombosis (sirolimus or everolimus) in patients with chronic total coronary occlusions (CTO) and to determine its clinical implications and related factors. MethodsData from the 12-month follow-up of the 207 patients included in the CIBELES trial with CTO were analyzed. ResultsStent thrombosis occurred in three patients, two definite and one probable (overall thrombosis rate: 1.4%). However, there were no cases of death or Q-wave myocardial infarction. In univariate analysis, patients with a higher incidence of stent thrombosis were those in whom the target vessel was the left anterior descending, who had single-vessel disease, were assigned to treatment with sirolimus-eluting stents, and those with smaller minimum luminal diameter immediately after the procedure. In multivariate analysis, the only independent predictor of stent thrombosis was minimal luminal diameter immediately after the procedure. ConclusionsThe rate of drug-eluting stent thrombosis in patients with CTO is relatively low (1.4%). The only independent predictor of stent thrombosis in this context was minimal luminal diameter after the procedure and the clinical presentation was in all cases relatively benign.

Platelet function testing in acute cardiac care - is there a role for prediction or prevention of stent thrombosis and bleeding?

The role of platelet function testing in acute coronary syndrome patients undergoing percutaneous coronary intervention remains controversial despite the fact that high platelet reactivity is an independent predictor of stent thrombosis and emerging evidence suggests also a link between low platelet reactivity and bleeding. In this expert opinion paper, the Study Group on Biomarkers in Cardiology of the Acute Cardiovascular Care Association and the Working Group on Thrombosis of the European Society of Cardiology aim to provide an overview of current evidence in this area and recommendations for practicing clinicians.

Drug-eluting stent thrombosis in the treatment of chronic total coronary occlusions: Incidence, presentation and related factors. Data from the CIBELES trial

Introduction and ObjectivesThe aim of this study was to analyze the incidence of drug-eluting stent thrombosis (sirolimus or everolimus) in patients with chronic total coronary occlusions (CTO) and to determine its clinical implications and related factors. MethodsData from the 12-month follow-up of the 207 patients included in the CIBELES trial with CTO were analyzed. ResultsStent thrombosis occurred in three patients, two definite and one probable (overall thrombosis rate: 1.4%). However, there were no cases of death or Q-wave myocardial infarction. In univariate analysis, patients with a higher incidence of stent thrombosis were those in whom the target vessel was the left anterior descending, who had single-vessel disease, were assigned to treatment with sirolimus-eluting stents, and those with smaller minimum luminal diameter immediately after the procedure. In multivariate analysis, the only independent predictor of stent thrombosis was minimal luminal diameter immediately after the procedure. ConclusionsThe rate of drug-eluting stent thrombosis in patients with CTO is relatively low (1.4%). The only independent predictor of stent thrombosis in this context was minimal luminal diameter after the procedure and the clinical presentation was in all cases relatively benign.

Stent Thrombosis after Coronary Stent Implantation: A Protective Effect of High-Dose Statin Therapy?

Objectives: To assess independent predictors of stent thrombosis (ST) in an all-comer trial. Methods: This is an observational case-control study based on a retrospective analysis of the Basel Stent Kosten Effektivitäts Trial (BASKET) (n = 826). Patients with ST were compared to controls with regard to baseline parameters. Multivariate models were performed to identify independent predictors of ST. Results: At 36 months, there were 53 (6.4%) patients with ST, 17 (32%) of whom had early ST and 36 (68%) of whom had late/very late ST. Patients with ST were at a higher cardiovascular risk but received lower doses of statins than the controls (n = 212). Stents in ST patients were longer, had more overlap and were not as well expanded, with significantly more remaining stenoses than the stents in the controls. Multivariable analysis revealed interventions in saphenous vein grafts, malapposed stents, an overlap >3 mm, complex coronary anatomy and treatment with low-dose/no statins as risk factors for ST, while interventions in saphenous vein grafts, underexpanded or malapposed stents, a history of myocardial infarction and treatment with low-dose/no statins were risk factors for late ST. Conclusions: The use of statins might have a protective effect against ST. This observation is new, hypothesis-generating and should be evaluated in an adequately powered randomized trial.

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

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.