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J Am Coll Cardiol, 2002; 40:1567-1572
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: CARDIAC CATHETERIZATION AND INTERVENTION

Frequency and correlates of coronary stent thrombosis in the modern era

Analysis of a single center registry

James L. Orford, MBChB, MPHa, Ryan Lennon, MSa, Steven Melby, RNa, Panayotis Fasseas, MDa, Malcolm R. Bell, MBBS, FRACPa, Charanjit S. Rihal, MD, FACCa, David R. Holmes, MD, FACCa and Peter B. Berger, MD, FACCa,*

* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received February 18, 2002; revised manuscript received June 14, 2002, accepted July 3, 2002.

* Reprint requests and correspondence: Dr. Peter Berger, Division of Cardiovascular Diseases, Mayo Clinic, W16, 200 First Street SW, Rochester, Minnesota 55905, USA.
berger.peter{at}mayo.edu

OBJECTIVES: The study examined the frequency, correlates, and outcome of patients with stent thrombosis within 30 days of stent placement.

BACKGROUND: Patients in trials evaluating stents or dual antiplatelet therapy to prevent coronary stent thrombosis have generally had narrow inclusion criteria; the extent to which stent thrombosis rates in such trials represent current practice, particularly with the availability of newer stents, is unclear.

METHODS: We performed a retrospective analysis of the Mayo Clinic Percutaneous Coronary Intervention database and identified all patients who received at least one coronary stent and dual antiplatelet therapy (aspirin and ticlopidine or clopidogrel for two to four weeks).

RESULTS: Four thousand five hundred nine patients underwent successful coronary stent implantation and were treated with dual antiplatelet therapy between July 1, 1994, and April 30, 2000. Stent thrombosis occurred in 23 patients (0.51%; 95% confidence interval 0.32%, 0.76%) within 30 days of stent placement. Multivariate analysis using bootstrap model selection to avoid over-fitting the model indicated that only the number of stents placed was an independent correlate of stent thrombosis (odds ratio 1.80, p < 0.001). The frequency of death and frequency of nonfatal myocardial infarction (MI) among the 23 patients with stent thrombosis were 48% and 39%, respectively.

CONCLUSIONS: Stent thrombosis is even more rare in the current era than in earlier trials. Number of stents placed was an independent correlate of stent thrombosis. Most patients who suffer stent thrombosis either die or suffer MI.

Abbreviations and Acronyms
  ACT
  accelerated clotting time
  ADP
  adenosine diphosphate
  CHF
  congestive heart failure
  CI
  confidence interval
  MI
  myocardial infarction
  OR
  odds ratio
  PCI
  percutaneous coronary intervention
  TIMI
  Thrombolysis In Myocardial Infarction




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