Home > Interventional Cardiology, Journal Club, Stent thrombosis > Journal Club 28 March 2012

Journal Club 28 March 2012

Article:

Clinical Presentation, Management, and Outcomes of Angiographically Documented Early, Late, and Very Late Stent Thrombosis

Presenter:

LAM

Abstract

Objectives

The aim of this study was to describe differences in treatment and in-hospital mortality
of early, late, and very late stent thrombosis (ST).
Background Early, late, and very late ST may differ in clinical presentation, management, and inhospital
outcomes.
Methods

We analyzed definite (angiographically documented) ST cases identified from February
2009 to June 2010 in the CathPCI Registry. We stratified events by timing of presentation: early (1
month), late (1 to 12 months), or very late (12 months) following stent implantation. Multivariable
logistic regression modeling was performed to compare in-hospital mortality for each type of ST
after adjusting for baseline comorbidities.
Results

During the study period, 7,315 ST events were identified in 7,079 of 401,662 patients (1.8%)
presenting with acute coronary syndromes. This ST cohort consisted of 1,391 patients with early ST
(19.6%), 1,370 with late ST (19.4%), and 4,318 with very late ST (61.0%). Subjects with early ST had a
higher prevalence of black race and diabetes, whereas subjects with very late ST had a higher prevalence
of white race and a lower prevalence of prior myocardial infarction or diabetes. In-hospital mortality
was significantly higher in early ST (7.9%) compared with late (3.8%) and very late ST (3.6%, p  0.001).
This lower mortality for late and very late ST persisted after multivariable adjustment (odds ratio:
0.53 [95% confidence interval (CI): 0.36 to 0.79] and 0.58 [95% CI: 0.43 to 0.79], respectively).
Conclusions

Significant differences exist in the presentation and outcomes of early, late, and very late ST.
Among patients with acute coronary syndromes who are undergoing percutaneous coronary intervention for
angiographically documented ST, early ST is associated with the highest in-hospital mortality.

Summary of Discussion

  • This was part 2 of 2 (see Journal Club 21 March 2012)
  • The collated large number of stent thromboses from this multicentre registry was noted. However, a number of limitations were noted:
    • the number of patients excluded because the time of stent implantation could not be established was significant. It  would have been instructive to know the mortality of this cohort.
    • 27% of patients did not have stent type documented
    • predictors of the events and differences in relation to timing were not presented and important issues such as duration of antiplatelet therapy were not presented
  • The dominant conclusions regarding mortality were acknowledged and the clinical characteristics noted.
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