Document Detail


Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents.
MedLine Citation:
PMID:  16490815     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Stent thrombosis (ST) is a serious complication of drug-eluting stent (DES) implantation regardless of the timing (acute, subacute, or late). The correlates of ST with DES are not yet completely elucidated. METHODS AND RESULTS: From a total cohort of 2974 consecutive patients treated with DES since April 2003, we identified 38 patients who presented with angiographic evidence of ST (1.27%). The ST occurred acutely in 5 patients, subacutely (< or =30 days) in 25 patients, and late (>30 days) in 8 patients. The clinical, angiographic, and procedural variables of these patients were compared with the remaining 2936 consecutive patients who underwent DES implantation and did not experience ST during a follow-up of 12 months. Logistic regression analysis was conducted to determine the correlates of ST. Compared with patients without ST, patients with ST had a higher frequency of diabetes, acute postprocedural renal failure, and chronic renal failure. There were more bifurcation lesions, type C lesions, and a trend for smaller-diameter stents. Discontinuation of clopidogrel was higher in these patients (36.8% versus 10.7%; P<0.0001). The mean duration to ST from the stent implantation was 8.9+/-8.5 days in subacute and 152.7+/-100.4 days in late thrombosis cases. Mortality was significantly higher in patients with ST compared with those without ST at 6 months (31% versus 3%; P<0.001). Multivariate analysis detected cessation of clopidogrel therapy, renal failure, bifurcation lesions, and in-stent restenosis as significant correlates of ST (P<0.05). CONCLUSIONS: ST continues to be a serious complication of contemporary DES use. Careful management is warranted in patients with renal failure and in those undergoing treatment for in-stent restenosis and bifurcations. Special focus on clopidogrel compliance may minimize the incidence of ST after DES implantation.
Authors:
Pramod K Kuchulakanti; William W Chu; Rebecca Torguson; Patrick Ohlmann; Seung-Woon Rha; Leonardo C Clavijo; Sang-Wook Kim; Ahn Bui; Natalie Gevorkian; Zhenyi Xue; Kimberly Smith; Jana Fournadjieva; William O Suddath; Lowell F Satler; Augusto D Pichard; Kenneth M Kent; Ron Waksman
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Publication Detail:
Type:  Journal Article     Date:  2006-02-20
Journal Detail:
Title:  Circulation     Volume:  113     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-28     Completed Date:  2006-03-31     Revised Date:  2006-09-18    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1108-13     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiography
Case-Control Studies
Drug Delivery Systems
Female
Follow-Up Studies
Graft Occlusion, Vascular / complications
Humans
Kidney Failure / complications
Male
Middle Aged
Paclitaxel / administration & dosage*
Sirolimus / administration & dosage*
Stents / adverse effects*
Thrombosis / diagnosis,  etiology*,  mortality
Ticlopidine / analogs & derivatives,  therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
33069-62-4/Paclitaxel; 53123-88-9/Sirolimus; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel
Comments/Corrections
Comment In:
Circulation. 2006 Aug 22;114(8):e362; author reply e363   [PMID:  16923764 ]

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


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