Stent thrombosis is the primary cause of ST-segment elevation myocardial infarction following coronary stent implantation: a five year follow-up of the SORT OUT II study

• Published in: PloS one Vol. 9; no. 11; p. e113399
• Main Authors: Kristensen, Søren Lund, Galløe, Anders M, Thuesen, Leif, Kelbæk, Henning, Thayssen, Per, Havndrup, Ole, Hansen, Peter Riis, Bligaard, Niels, Saunamäki, Kari, Junker, Anders, Aarøe, Jens, Abildgaard, Ulrik, Jeppesen, Jørgen L
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.11.2014; Public Library of Science (PLoS)
• Subjects: Age; Aged; Angina; Angina, Stable - complications; Aspirin; Biology and Life Sciences; Cardiology; Cardiovascular disease; Clinical medicine; Clopidogrel; Cohort Studies; Consortia; Coronary vessels; Drug-Eluting Stents - adverse effects; Electrocardiography; Female; Follow-Up Studies; Heart attacks; Hospitals; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - chemistry; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Implantation; Implants; Logistic Models; Male; Medicine and Health Sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - etiology; Odds Ratio; Patients; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - chemistry; Platelet Aggregation Inhibitors - therapeutic use; Polymers; Risk; Statins; Stents; Studies; Surgical implants; Thromboembolism; Thrombosis; Thrombosis - complications; Thrombosis - therapy; Ticlopidine - analogs & derivatives; Ticlopidine - chemistry; Ticlopidine - therapeutic use; Denmark
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0113399

The widespread use of coronary stents has exposed a growing population to the risk of stent thrombosis, but the importance in terms of risk of ST-segment elevation myocardial infarctions (STEMIs) remains unclear. We studied five years follow-up data for 2,098 all-comer patients treated with coronary stents in the randomized SORT OUT II trial (mean age 63.6 yrs. 74.8% men). Patients who following stent implantation were readmitted with STEMI were included and each patient was categorized ranging from definite- to ruled-out stent thrombosis according to the Academic Research Consortium definitions. Multivariate logistic regression was performed on selected covariates to assess odds ratios (ORs) for definite stent thrombosis. 85 patients (4.1%), mean age 62.7 years, 77.1% men, were admitted with a total of 96 STEMIs, of whom 60 (62.5%) had definite stent thrombosis. Notably, definite stent thrombosis was more frequent in female than male STEMI patients (81.8% vs. 56.8%, p =  .09), and in very late STEMIs (p = 0.06). Female sex (OR 3.53 [1.01-12.59]) and clopidogrel (OR 4.43 [1.03-19.01]) was associated with increased for definite stent thrombosis, whereas age, time since stent implantation, use of statins, initial PCI urgency (STEMI [primary PCI], NSTEMI/unstable angina [subacute PCI] or stable angina [elective PCI]), and glucose-lowering agents did not seem to influence risk of stent thrombosis. In a contemporary cohort of coronary stented patients, stent thrombosis was evident in more than 60% of subsequent STEMIs.