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Stent thrombosis after primary angioplasty for STEMI in relation to non-adherence to dual antiplatelet therapy over time: results of the HORIZONS-AMI trial.
MedLine Citation:
PMID:  23339809     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Aims: Rates of stent thrombosis (ST) after ST-elevation myocardial infarction (STEMI) may vary over time and the relationship of this complication with non-adherence to dual antiplatelet therapy (DAPT) during long-term follow-up remains unclear. Methods and results: We analysed 2,997 patients who were treated with at least one stent and in whom a non-target vessel ST did not occur during follow-up from the large-scale Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial of patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Aspirin was prescribed indefinitely, and a thienopyridine for at least six months. DAPT usage was evaluated according to the development of ST in four time periods (<1 month, 1-6 months, 6-12 months and >1 year from index stent implantation). DAPT non-usage was lowest within the first month, but was strongly associated with ST. During the 1-6 month period the relationship remained strong, but was absent in the 6-12 month period. Beyond one year, ST was associated with non-usage of aspirin but was paradoxically more common in patients taking a thienopyridine. Conclusions: The relationship between stent thrombosis and non-adherence to DAPT varies over time. It is strong within the first month, remains important until six-month follow-up but fades afterwards. Very late ST is associated with both DAPT and aspirin alone but not with thienopyridine non-adherence. Clinical trial registration: HORIZONS-AMI - registered at clinicaltrials.gov #NCT00433966.
Authors:
George D Dangas; Bimmer E Claessen; Roxana Mehran; Ke Xu; Gregg W Stone
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology     Volume:  8     ISSN:  1969-6213     ISO Abbreviation:  EuroIntervention     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101251040     Medline TA:  EuroIntervention     Country:  France    
Other Details:
Languages:  eng     Pagination:  1033-9     Citation Subset:  IM    
Affiliation:
Mount Sinai Medical Center, New York, NY, USA.
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