Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients

Objective We sought to determine the incidence, angiographic predictors, and impact of stent thrombosis (ST). Background Given the high mortality after ST, this study emphasises the importance of ongoing efforts to identify angiographic predictors of ST. Methods All consecutive patients with angiogr...

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Published in:Netherlands heart journal 2019-06, Vol.27 (6), p.321-329
Main Authors: Rozemeijer, R., Wing Wong, C., Leenders, G., Timmers, L., Koudstaal, S., Rittersma, S. Z., Kraaijeveld, A., Bots, M., Doevendans, P., Stella, P., Voskuil, M.
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Angina pectoris
Angioplasty
Cardiology
Diabetes
Ejection fraction
Hypertension
Kappa coefficient
Medical Education
Medical imaging
Medicine
Medicine & Public Health
Mortality
Original
Original Article
Patients
Pharmacy
Software
Stents
Thrombosis
Vein & artery diseases
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container_start_page 321
container_title Netherlands heart journal
container_volume 27
creator Rozemeijer, R.
Wing Wong, C.
Leenders, G.
Timmers, L.
Koudstaal, S.
Rittersma, S. Z.
Kraaijeveld, A.
Bots, M.
Doevendans, P.
Stella, P.
Voskuil, M.
description Objective We sought to determine the incidence, angiographic predictors, and impact of stent thrombosis (ST). Background Given the high mortality after ST, this study emphasises the importance of ongoing efforts to identify angiographic predictors of ST. Methods All consecutive patients with angiographically confirmed ST between 2010 and 2016 were 1:4 matched for (1) percutaneous coronary intervention (PCI) indication and (2) index date ±6 weeks to randomly selected controls. Index PCI angiograms were reassessed by two independent cardiologists. A multivariable conditional logistic regression model was built to identify independent predictors of ST. Results Of 6,545 consecutive patients undergoing PCI, 55 patients [0.84%, 95% confidence interval (CI) 0.63–1.10%] presented with definite ST. Multivariable logistic regression identified dual antiplatelet therapy (DAPT) non-use as the strongest predictor of ST (odds ratio (OR) 10.9, 95% CI 2.47–48.5, p  
doi_str_mv 10.1007/s12471-019-1253-2
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Z. ; Kraaijeveld, A. ; Bots, M. ; Doevendans, P. ; Stella, P. ; Voskuil, M.</creator><creatorcontrib>Rozemeijer, R. ; Wing Wong, C. ; Leenders, G. ; Timmers, L. ; Koudstaal, S. ; Rittersma, S. Z. ; Kraaijeveld, A. ; Bots, M. ; Doevendans, P. ; Stella, P. ; Voskuil, M.</creatorcontrib><description>Objective We sought to determine the incidence, angiographic predictors, and impact of stent thrombosis (ST). Background Given the high mortality after ST, this study emphasises the importance of ongoing efforts to identify angiographic predictors of ST. Methods All consecutive patients with angiographically confirmed ST between 2010 and 2016 were 1:4 matched for (1) percutaneous coronary intervention (PCI) indication and (2) index date ±6 weeks to randomly selected controls. Index PCI angiograms were reassessed by two independent cardiologists. A multivariable conditional logistic regression model was built to identify independent predictors of ST. Results Of 6,545 consecutive patients undergoing PCI, 55 patients [0.84%, 95% confidence interval (CI) 0.63–1.10%] presented with definite ST. Multivariable logistic regression identified dual antiplatelet therapy (DAPT) non-use as the strongest predictor of ST (odds ratio (OR) 10.9, 95% CI 2.47–48.5, p  &lt; 0.001), followed by: stent underexpansion (OR 5.70, 95% CI 2.39–13.6, p  &lt; 0.001), lesion complexity B2/C (OR 4.32, 95% CI 1.43–13.1, p  = 0.010), uncovered edge dissection (OR 4.16, 95% CI 1.47–11.8, p  = 0.007), diabetes mellitus (OR 3.23, 95% CI 1.25–8.36, p  = 0.016), and residual coronary artery disease at the stent edge (OR 3.02, 95% CI 1.02–8.92, p  = 0.045). ST was associated with increased rates of mortality as analysed by Kaplan-Meier estimates (27.3 vs 11.3%, p log-rank  &lt; 0.001) and adjusted Cox proportional-hazard regression (hazard ratio 2.29, 95% CI 1.03–5.10, p  = 0.042). Conclusions ST remains a serious complication following PCI with a high rate of mortality. DAPT non-use was associated with the highest risk of ST, followed by various angiographic parameters and high lesion complexity.</description><identifier>ISSN: 1568-5888</identifier><identifier>EISSN: 1876-6250</identifier><identifier>DOI: 10.1007/s12471-019-1253-2</identifier><identifier>PMID: 30895527</identifier><language>eng</language><publisher>Houten: Bohn Stafleu van Loghum</publisher><subject>Acute coronary syndromes ; Angina pectoris ; Angioplasty ; Cardiology ; Diabetes ; Ejection fraction ; Hypertension ; Kappa coefficient ; Medical Education ; Medical imaging ; Medicine ; Medicine &amp; Public Health ; Mortality ; Original ; Original Article ; Patients ; Pharmacy ; Software ; Stents ; Thrombosis ; Vein &amp; artery diseases</subject><ispartof>Netherlands heart journal, 2019-06, Vol.27 (6), p.321-329</ispartof><rights>The Author(s) 2019</rights><rights>The Author(s) 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4512-5257bebfd286198586fbd3be57ada350055ff95e8dde49cb229d846e7f765f593</citedby><cites>FETCH-LOGICAL-c4512-5257bebfd286198586fbd3be57ada350055ff95e8dde49cb229d846e7f765f593</cites><orcidid>0000-0002-8185-7959</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2729540101/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2729540101?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,25731,27901,27902,36989,36990,44566,53766,53768,74869</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30895527$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rozemeijer, R.</creatorcontrib><creatorcontrib>Wing Wong, C.</creatorcontrib><creatorcontrib>Leenders, G.</creatorcontrib><creatorcontrib>Timmers, L.</creatorcontrib><creatorcontrib>Koudstaal, S.</creatorcontrib><creatorcontrib>Rittersma, S. Z.</creatorcontrib><creatorcontrib>Kraaijeveld, A.</creatorcontrib><creatorcontrib>Bots, M.</creatorcontrib><creatorcontrib>Doevendans, P.</creatorcontrib><creatorcontrib>Stella, P.</creatorcontrib><creatorcontrib>Voskuil, M.</creatorcontrib><title>Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients</title><title>Netherlands heart journal</title><addtitle>Neth Heart J</addtitle><addtitle>Neth Heart J</addtitle><description>Objective We sought to determine the incidence, angiographic predictors, and impact of stent thrombosis (ST). Background Given the high mortality after ST, this study emphasises the importance of ongoing efforts to identify angiographic predictors of ST. Methods All consecutive patients with angiographically confirmed ST between 2010 and 2016 were 1:4 matched for (1) percutaneous coronary intervention (PCI) indication and (2) index date ±6 weeks to randomly selected controls. Index PCI angiograms were reassessed by two independent cardiologists. A multivariable conditional logistic regression model was built to identify independent predictors of ST. Results Of 6,545 consecutive patients undergoing PCI, 55 patients [0.84%, 95% confidence interval (CI) 0.63–1.10%] presented with definite ST. Multivariable logistic regression identified dual antiplatelet therapy (DAPT) non-use as the strongest predictor of ST (odds ratio (OR) 10.9, 95% CI 2.47–48.5, p  &lt; 0.001), followed by: stent underexpansion (OR 5.70, 95% CI 2.39–13.6, p  &lt; 0.001), lesion complexity B2/C (OR 4.32, 95% CI 1.43–13.1, p  = 0.010), uncovered edge dissection (OR 4.16, 95% CI 1.47–11.8, p  = 0.007), diabetes mellitus (OR 3.23, 95% CI 1.25–8.36, p  = 0.016), and residual coronary artery disease at the stent edge (OR 3.02, 95% CI 1.02–8.92, p  = 0.045). ST was associated with increased rates of mortality as analysed by Kaplan-Meier estimates (27.3 vs 11.3%, p log-rank  &lt; 0.001) and adjusted Cox proportional-hazard regression (hazard ratio 2.29, 95% CI 1.03–5.10, p  = 0.042). Conclusions ST remains a serious complication following PCI with a high rate of mortality. DAPT non-use was associated with the highest risk of ST, followed by various angiographic parameters and high lesion complexity.</description><subject>Acute coronary syndromes</subject><subject>Angina pectoris</subject><subject>Angioplasty</subject><subject>Cardiology</subject><subject>Diabetes</subject><subject>Ejection fraction</subject><subject>Hypertension</subject><subject>Kappa coefficient</subject><subject>Medical Education</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Mortality</subject><subject>Original</subject><subject>Original Article</subject><subject>Patients</subject><subject>Pharmacy</subject><subject>Software</subject><subject>Stents</subject><subject>Thrombosis</subject><subject>Vein &amp; artery diseases</subject><issn>1568-5888</issn><issn>1876-6250</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNp1kctuFDEQRVsIRELgA9igltiwmAbb3eUHi0go4hEpEhtYW267esZRj93Y3SPNil_hW_Jl8TAhPCRWLuueulWlW1XPKXlNCRFvMmWdoA2hqqEM2oY9qE6pFLzhDMjDUgOXDUgpT6onOV8TAoJR8bg6aYlUAEycVt8vg_UOg8VVbcLax3Uy08bb8nG1HX3w1oz1lNB5O8eUVz8Fv52Mnes41HnGMNfzJsVtH7PPb2tz84M3ezSpzkva4f5A8RV0UNsYMtpl9jusJzP70pmfVo8GM2Z8dveeVV8_vP9y8am5-vzx8uLdVWM7oKwBBqLHfnBMcqokSD70ru0RhHGmhXIZDIMClM5hp2zPmHKy4ygGwWEA1Z5V50ffaem36GyZncyop-S3Ju11NF7_rQS_0eu40xzatmVdMXh1Z5DitwXzrLc-WxxHEzAuWTOqypJKKF7Ql_-g13FJoZynmWAKOkIJLRQ9UjbFnBMO98tQog_x6mO8usSrD_FqVnpe_HnFfcevPAvAjkAuUlhj-j36_663m1eyOw</recordid><startdate>20190601</startdate><enddate>20190601</enddate><creator>Rozemeijer, R.</creator><creator>Wing Wong, C.</creator><creator>Leenders, G.</creator><creator>Timmers, L.</creator><creator>Koudstaal, S.</creator><creator>Rittersma, S. Z.</creator><creator>Kraaijeveld, A.</creator><creator>Bots, M.</creator><creator>Doevendans, P.</creator><creator>Stella, P.</creator><creator>Voskuil, M.</creator><general>Bohn Stafleu van Loghum</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8185-7959</orcidid></search><sort><creationdate>20190601</creationdate><title>Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients</title><author>Rozemeijer, R. ; Wing Wong, C. ; Leenders, G. ; Timmers, L. ; Koudstaal, S. ; Rittersma, S. 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Z.</creatorcontrib><creatorcontrib>Kraaijeveld, A.</creatorcontrib><creatorcontrib>Bots, M.</creatorcontrib><creatorcontrib>Doevendans, P.</creatorcontrib><creatorcontrib>Stella, P.</creatorcontrib><creatorcontrib>Voskuil, M.</creatorcontrib><collection>Springer Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Netherlands heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rozemeijer, R.</au><au>Wing Wong, C.</au><au>Leenders, G.</au><au>Timmers, L.</au><au>Koudstaal, S.</au><au>Rittersma, S. Z.</au><au>Kraaijeveld, A.</au><au>Bots, M.</au><au>Doevendans, P.</au><au>Stella, P.</au><au>Voskuil, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients</atitle><jtitle>Netherlands heart journal</jtitle><stitle>Neth Heart J</stitle><addtitle>Neth Heart J</addtitle><date>2019-06-01</date><risdate>2019</risdate><volume>27</volume><issue>6</issue><spage>321</spage><epage>329</epage><pages>321-329</pages><issn>1568-5888</issn><eissn>1876-6250</eissn><abstract>Objective We sought to determine the incidence, angiographic predictors, and impact of stent thrombosis (ST). Background Given the high mortality after ST, this study emphasises the importance of ongoing efforts to identify angiographic predictors of ST. Methods All consecutive patients with angiographically confirmed ST between 2010 and 2016 were 1:4 matched for (1) percutaneous coronary intervention (PCI) indication and (2) index date ±6 weeks to randomly selected controls. Index PCI angiograms were reassessed by two independent cardiologists. A multivariable conditional logistic regression model was built to identify independent predictors of ST. Results Of 6,545 consecutive patients undergoing PCI, 55 patients [0.84%, 95% confidence interval (CI) 0.63–1.10%] presented with definite ST. Multivariable logistic regression identified dual antiplatelet therapy (DAPT) non-use as the strongest predictor of ST (odds ratio (OR) 10.9, 95% CI 2.47–48.5, p  &lt; 0.001), followed by: stent underexpansion (OR 5.70, 95% CI 2.39–13.6, p  &lt; 0.001), lesion complexity B2/C (OR 4.32, 95% CI 1.43–13.1, p  = 0.010), uncovered edge dissection (OR 4.16, 95% CI 1.47–11.8, p  = 0.007), diabetes mellitus (OR 3.23, 95% CI 1.25–8.36, p  = 0.016), and residual coronary artery disease at the stent edge (OR 3.02, 95% CI 1.02–8.92, p  = 0.045). ST was associated with increased rates of mortality as analysed by Kaplan-Meier estimates (27.3 vs 11.3%, p log-rank  &lt; 0.001) and adjusted Cox proportional-hazard regression (hazard ratio 2.29, 95% CI 1.03–5.10, p  = 0.042). Conclusions ST remains a serious complication following PCI with a high rate of mortality. DAPT non-use was associated with the highest risk of ST, followed by various angiographic parameters and high lesion complexity.</abstract><cop>Houten</cop><pub>Bohn Stafleu van Loghum</pub><pmid>30895527</pmid><doi>10.1007/s12471-019-1253-2</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-8185-7959</orcidid><oa>free_for_read</oa></addata></record>
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subjects Acute coronary syndromes
Angina pectoris
Angioplasty
Cardiology
Diabetes
Ejection fraction
Hypertension
Kappa coefficient
Medical Education
Medical imaging
Medicine
Medicine & Public Health
Mortality
Original
Original Article
Patients
Pharmacy
Software
Stents
Thrombosis
Vein & artery diseases
title Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients
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