Frequency and correlates of coronary stent thrombosis in the modern era: Analysis of a single center registry

• Published in: Journal of the American College of Cardiology 2002-11, Vol.40 (9), p.1567-1572
• Main Authors: ORFORD, James L, LENNON, Ryan, MELBY, Steven, FASSEAS, Panayotis, BELL, Malcolm R, RIHAL, Charanjit S, HOLMES, David R, BERGER, Peter B
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angina, Unstable - therapy; Angioplasty; Angioplasty, Balloon, Coronary - adverse effects; Aspirin; Aspirin - administration & dosage; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Clopidogrel; Confidence intervals; Coronary Angiography; Coronary heart disease; Coronary Thrombosis - epidemiology; Coronary Thrombosis - etiology; Coronary Thrombosis - prevention & control; Drug Therapy, Combination; Female; Heart; Heart attacks; Heart failure; Hospitalization; Humans; Male; Medical records; Medical sciences; Middle Aged; Multivariate Analysis; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - therapeutic use; Registries; Retrospective Studies; Review boards; Risk Factors; Stents; Stents - adverse effects; Thrombosis; Ticlopidine - administration & dosage; Ticlopidine - analogs & derivatives; Treatment Outcome; Ulcers
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(02)02374-4

The study examined the frequency, correlates, and outcome of patients with stent thrombosis within 30 days of stent placement. Patients in trials evaluating stents or dual antiplatelet therapy to prevent coronary stent thrombosis have generally had narrow inclusion criteria; the extent to which stent thrombosis rates in such trials represent current practice, particularly with the availability of newer stents, is unclear. We performed a retrospective analysis of the Mayo Clinic Percutaneous Coronary Intervention database and identified all patients who received at least one coronary stent and dual antiplatelet therapy (aspirin and ticlopidine or clopidogrel for two to four weeks). Four thousand five hundred nine patients underwent successful coronary stent implantation and were treated with dual antiplatelet therapy between July 1, 1994, and April 30, 2000. Stent thrombosis occurred in 23 patients (0.51%; 95% confidence interval 0.32%, 0.76%) within 30 days of stent placement. Multivariate analysis using bootstrap model selection to avoid over-fitting the model indicated that only the number of stents placed was an independent correlate of stent thrombosis (odds ratio 1.80, p < 0.001). The frequency of death and frequency of nonfatal myocardial infarction (MI) among the 23 patients with stent thrombosis were 48% and 39%, respectively. 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.