Incidence and Correlates of Drug-Eluting Stent Thrombosis in Routine Clinical Practice : 4-Year Results From a Large 2-Institutional Cohort Study

• Published in: Journal of the American College of Cardiology Vol. 52; no. 14; pp. 1134 - 1140
• Main Authors: WENAWESER, Peter, DAEMEN, Joost, KUKREJA, Neville, MEIER, Bernhard, SERRUYS, Patrick W, WINDECKER, Stephan, ZWAHLEN, Marcel, VAN DOMBURG, Ron, JÜNI, Peter, VAINA, Sophia, HELLIGE, Gerrit, TSUCHIDA, Keiichi, MORGER, Cyrill, BOERSMA, Eric
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 30.09.2008; Elsevier Limited
• Subjects: Acute coronary syndromes; Age; Aged; Antibiotics, Antineoplastic - administration & dosage; Antineoplastic Agents, Phytogenic - administration & dosage; Biological and medical sciences; Blood clots; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Confidence intervals; Coronary Thrombosis - etiology; Coronary Thrombosis - mortality; Diabetes; Drug-Eluting Stents - adverse effects; Family medical history; Female; Follow-Up Studies; Heart attacks; Hospitals; Humans; Hypertension; Incidence; Male; Medical sciences; Middle Aged; Mortality; Netherlands - epidemiology; Paclitaxel - administration & dosage; Postoperative Complications - epidemiology; Questionnaires; Risk Factors; Sirolimus - administration & dosage; Stents; Studies; Switzerland - epidemiology; Thrombosis; Time Factors; Switzerland; Netherlands; Vascular disease; Prognosis; Cohort study; Professional practice; Cardiovascular disease; Circulatory system; Cardiology; Epidemiology; Long term; Drug eluting stent; Thrombosis; Incidence
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2008.07.006

We sought to determine the risk of late stent thrombosis (ST) during long-term follow-up beyond 3 years, searched for predictors, and assessed the impact of ST on overall mortality. Late ST was reported to occur at an annual rate of 0.6% up to 3 years after drug-eluting stent (DES) implantation. A total of 8,146 patients underwent percutaneous coronary intervention with a sirolimus-eluting stent (SES) (n=3,823) or paclitaxel-eluting stent (PES) (n=4,323) and were followed up to 4 years after stent implantation. Dual antiplatelet treatment was prescribed for 6 to 12 months. Definite ST occurred in 192 of 8,146 patients with an incidence density of 1.0/100 patient-years and a cumulative incidence of 3.3% at 4 years. The hazard of ST continued at a steady rate of 0.53% (95% confidence interval [CI]: 0.44 to 0.64) between 30 days and 4 years. Diabetes was an independent predictor of early ST (hazard ratio [HR]: 1.96; 95% CI: 1.18 to 3.28), and acute coronary syndrome (HR: 2.21; 95% CI: 1.39 to 3.51), younger age (HR: 0.97; 95% CI: 0.95 to 0.99), and use of PES (HR: 1.67; 95% CI: 1.08 to 2.56) were independent predictors of late ST. Rates of death and myocardial infarction at 4 years were 10.6% and 4.6%, respectively. Late ST occurs steadily at an annual rate of 0.4% to 0.6% for up to 4 years. Diabetes is an independent predictor of early ST, whereas acute coronary syndrome, younger age, and PES implantation are associated with late ST.