Stent thrombosis complications
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The overall poor prognosis of stent thrombosis(ST) makes this rare complication, a devastating and hence extremely important one. Complications include:
- Recurrence of stent thrombosis
- Myocardial infarction
- Death
Myocardial infarction/death
- A sub-analysis of TRITON-TIMI 38 study showed that stent thrombosis was associated with death or myocardial infarction in 89% (186/210) of patients[1]. In follow up studies after stent thrombosis, recurrent stent thrombosis has also been noticed, especially during the following six months[2].
- Van Werkum et al[3] studied the long term outcome after definite stent thrombosis. 431 patients with definite stent thrombosis were enrolled in this multicenter registry. The primary end point was the composite of cardiac death and definite recurrent ST. The primary end point occurred in 111 patients after a median follow-up of 27.1 months. Clinical outcome was not affected by the type of previously implanted stent (drug-eluting or bare-metal stent) or the category of ST (early versus late). Authors concluded that the long-term clinical outcome after a first definite ST is unfavorable, with a high mortality and recurrence rate. Diabetes mellitus, left ventricular ejection fraction <45%, long total stent length, complex coronary lesions, TIMI flow grade <3 after percutaneous coronary intervention, and implantation of an additional coronary stent during the emergent percutaneous coronary intervention for the ST were associated with this unfavorable outcome.
- A pooled analysis of multicenter coronary stent clinical trials showed that in patients with angiographic stent thrombosis the incidence of death or myocardial infarction was 64.4% at the time of stent thrombosis and had a 6-month mortality rate of 8.9%.[4]
- One year mortality rate was 16% and stent thrombosis recurrence was 4.6% in a multicenter study in Spain.[5]
- The mortality rate was 31% and MI was seen in 83% of patients with stent thrombosis at 4 years follow-up in a pooled analysis.[6]
- In a study to investigate the efficacy and outcome of emergency percutaneous coronary interventions (PCI) in patients with stent thrombosis, 6 month major adverse clinical events were comprised of death (11%), reinfarction (16%), and recurrent stent thrombosis (12%).[7]
Recurrence of stent thrombosis
- Incidence of recurrent stent thrombosis has been reported as 12% at 6-months.[7] Another study reported 1 year recurrence rate of 4.6% in patients with DES.[5] Dutch stent thrombosis registry reported 20.1% 3 year recurrence rate of stent thombosis.[3]
Prognosis is worse in patients with myocardial infarction secondary to stent thrombosis when compared to those who develop MI secondary to thrombus at a new region i.e when thrombosis occurs in any part of artery other than within the stent.
References
- ↑ Wiviott SD, Braunwald E, McCabe CH; et al. (2008). "Intensive oral antiplatelet therapy for reduction of ischaemic events including stent thrombosis in patients with acute coronary syndromes treated with percutaneous coronary intervention and stenting in the TRITON-TIMI 38 trial: a subanalysis of a randomised trial". Lancet. 371 (9621): 1353–63. doi:10.1016/S0140-6736(08)60422-5. PMID 18377975. Unknown parameter
|month=ignored (help) - ↑ Gallego L, Martínez-Sellés M, García E; et al. (2009). "Characteristics and outcome of angiographically confirmed stent thrombosis". Rev Esp Cardiol. 62 (2): 220–3. PMID 19232197. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 van Werkum JW, Heestermans AA, de Korte FI; et al. (2009). "Long-term clinical outcome after a first angiographically confirmed coronary stent thrombosis: an analysis of 431 cases". Circulation. 119 (6): 828–34. doi:10.1161/CIRCULATIONAHA.108.799403. PMID 19188507. Unknown parameter
|month=ignored (help) - ↑ Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ; et al. (2001). "Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials". Circulation. 103 (15): 1967–71. PMID 11306525.
- ↑ 5.0 5.1 de la Torre-Hernández JM, Alfonso F, Hernández F, Elizaga J, Sanmartin M, Pinar E; et al. (2008). "Drug-eluting stent thrombosis: results from the multicenter Spanish registry ESTROFA (Estudio ESpañol sobre TROmbosis de stents FArmacoactivos)". J Am Coll Cardiol. 51 (10): 986–90. doi:10.1016/j.jacc.2007.10.057. PMID 18325436.
- ↑ Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE (2007). "Stent thrombosis in randomized clinical trials of drug-eluting stents". N Engl J Med. 356 (10): 1020–9. doi:10.1056/NEJMoa067731. PMID 17296821.
- ↑ 7.0 7.1 Wenaweser P, Rey C, Eberli FR, Togni M, Tüller D, Locher S; et al. (2005). "Stent thrombosis following bare-metal stent implantation: success of emergency percutaneous coronary intervention and predictors of adverse outcome". Eur Heart J. 26 (12): 1180–7. doi:10.1093/eurheartj/ehi135. PMID 15728650.