Incidence of stent thrombosis in BMS
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Multiple contemporary studies involving single center and multi center experience suggests an overall incidence of 0.5 % - 2.5 %. (1,2,3,4,5) There is some variation of these numbers with the definitions used. For instance, in a recent study of 8847 patients who received a BMS, a cumulative incidence of definite, probable or possible ST over 15 months was 2.15% and that for definite ST was 0.61% (6) In a study involving serial angioscopy after sirolimus-eluting stent (SES) implantation at 4, 11, and 21.2 ±2.2 months no BMS had thrombus in 11 patients. (11)
Incidence of early ST in BMS
- For purposes of discussion this group would include
- intra-procedural ST
- acute ST up to 24 hrs
- subacute – 24 hrs to 30 days
In the current environment the overall incidence of acute ST with BMS is ≈ 0.5%.
In study of 7484 patients with (intra vascular ultrasound study) IVUS before and after stenting, incidence of ST was 0.4% up to a week. The median time of ST was 24 hours and the minimum time was 1 hour. (7)
In the current environment the overall incidence of acute ST with BMS is ≈ 0.5%
In a retrospective analysis 4509 patients the rate of subacute ST was 0.51%. (8)
In a study of 7484 patients with IVUS interrogation of the stent, ST of 0.4% was reported up to one week with a median time of 24 hours. (7)
The incidence of subacute ST could be higher in special patient populations. In a group of 40 patients who underwent non cardiac surgery following BMS, the incidence of ST while on two antiplatelet agents appeared to be 2.5 % (one patient out of 40). (9)
Incidence of late ST of BMS
For purposes of discussion this would include ST from 30 days till up to 3 years or longer
- This would include
- Late ST –> 30 days to one year
- Very late ST –> more than one year, but generally less than 3 years
- Later than 3 years
The reported incidence in this group ranges between 0-0.5%. Given the paucity of data only assumptions can be made for the group beyond 1-3 years.
The incidence of late ST with BMS was 0.28% in a meta-analysis of 14 trials looking at 6675 patients. (10)
It appears that ST in the very late group is exceedingly rare.
In a meta-analysis of 14 trials looking at 6675 patients no patient presentetd with very late ST of BMS. How ever regular follow up of most patients confined to one year or less. (10)
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References
(1) Lisette Okkels Jensen et al Stent Thrombosis, Myocardial Infarction, and Death After Drug-Eluting and Bare-Metal Stent Coronary Interventions; J Am Coll Cardiol 2007;50:463–70
(2) Leon, MB, Baim, DS, Popma, JJ, et al, for the Stent Anticoagulation Restenosis Study Investigators. A clinical trial comparing three antithrombotic-drug regimens after coronary artery stenting. N Engl J Med 1998; 339:1665.
(3) Moreno, R, Fernandez, C, Hernandez, R, et al. Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies. J Am Coll Cardiol 2005; 45:954.
(4) Cutlip, DE, Baim, DS, Ho, KK, et al. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001; 103:1967.
(5) Schuhlen, H, Kastrati, A, Pache, J, et al. Incidence of thrombotic occlusion and major adverse cardiac events between two and four weeks after coronary stent placement: analysis of 5,678 patients with a four-week ticlopidine regimen. J Am Coll Cardiol 2001; 37:2066
(6) Lisette Okkels Jensen et al Stent Thrombosis, Myocardial Infarction, and Death After Drug-Eluting and Bare-Metal Stent Coronary Interventions; J Am Coll Cardiol 2007;50:463–70
(7) Edouard Cheneau et al, Predictors of Subacute Stent Thrombosis: Results of a Systematic Intravascular Ultrasound Study Circulation 2003;108;43-47
(8) Orford JL, Lennon R, Melby S, et al. Frequency and correlates of coronary stent thrombosis in the modern era: analysis of a single center registry. J Am Coll Cardiol 2002;40:1567–72
(9) Kaluza GL, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of non-cardiac surgery soon after coronary stenting. J Am Coll Cardiol 2000;35:1288 –94.
(10) Bavry AA, Kumbhani DJ, Helton TJ, Borek PP, Mood GR, Bhatt DL. Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials. Am J Med. 2006;119:1056 –1061.
(11) Masaki Awata, Jun-ichi Kotani et al; Serial Angioscopic Evidence of Incomplete Neointimal Coverage After Sirolimus-Eluting Stent Implantation. Comparison With Bare-Metal Stents Circulation published online Aug 7, 2007