Document Detail


Angiographic stent thrombosis at coronary bifurcations: short- and long-term prognosis.
MedLine Citation:
PMID:  22230151     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to describe the presentation, management, and outcomes of patients presenting with angiographic definite stent thrombosis (ST) at coronary bifurcations.
BACKGROUND: The development of drug-eluting stents has made it increasingly feasible to treat bifurcation lesions percutaneously. However, ST at coronary bifurcations may be associated with greater mortality than ST elsewhere.
METHODS: We analyzed a multicenter California registry comprising all cases of angiographic definite ST at 5 academic hospitals from 2005 to 2010. Stenting was defined as occurring at a bifurcation if the main vessel stent crossed a side branch ≥2.0 mm in diameter (provisional single-stent approach), or if there was a prior 2-stent bifurcation approach.
RESULTS: Among 173 cases of angiographic definite ST, we identified 20 cases of ST at coronary bifurcations. Nine of 20 bifurcation ST (45%) occurred with a stent present in both the parent and branch vessel. Eight cases had thrombus present in both the parent and side branch vessels. In-hospital mortality was much higher for subjects with bifurcation ST than ST at a nonbifurcation site (20% vs. 2%, p < 0.0001). During a median follow-up of 2.3 years, ST at a coronary bifurcation was associated with increased long-term mortality (hazard ratio [HR]: 3.3, 95% confidence interval [CI]: 1.4 to 7.7, p = 0.007) and a significantly higher risk for major adverse cardiovascular events (HR: 2.2, 95% CI: 1.04 to 4.8, p = 0.04) relative to ST at a nonbifurcation site.
CONCLUSIONS: ST at coronary bifurcations is associated with a higher in-hospital and long-term mortality than ST at nonbifurcation lesions. (Stent Thrombus in Acute Coronary Syndromes; NCT00931502).
Authors:
Ehrin J Armstrong; Khung Keong Yeo; Usman Javed; Ehtisham Mahmud; Mitul Patel; Kendrick A Shunk; John S MacGregor; Reginald I Low; Jason H Rogers
Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  5     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-10     Completed Date:  2012-05-16     Revised Date:  2012-08-29    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  57-63     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California 95817, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00931502
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MeSH Terms
Descriptor/Qualifier:
Aged
California
Confidence Intervals
Coronary Angiography / instrumentation*,  methods
Coronary Artery Disease / diagnosis,  pathology
Coronary Restenosis / diagnosis*,  pathology
Coronary Vessels / pathology*
Drug-Eluting Stents*
Feasibility Studies
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Prognosis
Registries
Risk Assessment
Statistics as Topic

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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