A Clinical Risk Score for Prediction of Stent Thrombosis

• Published in: The American journal of cardiology Vol. 102; no. 5; pp. 541 - 545
• Main Authors: Baran, Kenneth W., MD, Lasala, John M., MD, PhD, Cox, David A., MD, Song, Aijun, MS, Deshpande, Mahesh C., MS, MBA, Jacoski, Mary V., MS, Mascioli, Stephen R., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2008; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Blood Vessel Prosthesis; Cardiology; Cardiology. Vascular system; Cardiovascular; Coated Materials, Biocompatible; Coronary Angiography; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - epidemiology; Follow-Up Studies; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - epidemiology; Humans; Incidence; Male; Medical imaging; Medical sciences; Middle Aged; Multivariate analysis; Prosthesis Failure; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk; Risk Factors; ROC Curve; Severity of Illness Index; Stents; Thrombosis; United States - epidemiology; Vascular disease; Endoprosthesis; Risk factor; Prediction; Instrumentation therapy; Cardiovascular disease; Risk; Circulatory system; Cardiology; Stent; Thrombosis
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.04.068

The aim was to develop a clinically useful patient risk score predictive for stent thrombosis (ST). Using readily available baseline clinical and angiographic characteristics, a Cox proportional hazards multivariate model was used to identify significant (p <0.10) predictors of ST through 1 year in 2,487 patients receiving a TAXUS Express (Boston Scientific Corp., Natick, Massachusetts) drug-eluting stent (DES) in the ARRIVE 1 registry. Hazard ratios of significant predictors were rounded to an integer value ranging from 2 to 5. These values were summed for a maximum possible score of 24. The model was validated using 1-year data from a similar DES data set (ARRIVE 2, n = 4,820 patients). The 8 significant predictors found were thienopyridine therapy discontinuation before 6 months, insulin-requiring diabetes, smoker at baseline, left main stent placement, multiple stent placement, lesion length >28 mm, moderate to severe lesion calcification, and reference vessel diameter <3 mm. Model discrimination was high, indicated by an area under the receiver-operator characteristic curve of 0.819. Stratification of patients into low-, medium-, and high-risk groups showed that ST developed in 0.8% of patients with a score <6, 3.6% of patients with a score of 7 to 13, and 12.6% of patients with a score ≥14. In conclusion, using 8 readily available clinical and angiographic characteristics, we defined an ST risk score for patients receiving a DES during the first year. Analysis of patients from ARRIVE 1 and 2 showed that most (73%) were in the lowest risk category, with 25% in the moderate risk category. Less than 2% were at highest risk of developing ST.