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J Am Coll Cardiol, 2007; 50:573-583, doi:10.1016/j.jacc.2007.04.059 (Published online 29 July 2007). © 2007 by the American College of Cardiology Foundation

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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Angiographic Stent Thrombosis After Routine Use of Drug-Eluting Stents in ST-Segment Elevation Myocardial Infarction

The Importance of Thrombus Burden

Erasmus Medical Center, Department of Interventional Cardiology, Thoraxcenter, Rotterdam, the Netherlands.

Manuscript received December 12, 2006; revised manuscript received March 26, 2007, accepted April 10, 2007.

^_* Reprint requests and correspondence: Dr. Georgios Sianos, Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands. (Email: g.sianos{at}erasmusmc.nl).

Objectives: This study sought to investigate the impact of thrombus burden on the clinical outcome and angiographic infarct-related artery stent thrombosis (IRA-ST) in patients routinely treated with drug-eluting stent (DES) implantation for ST-segment elevation myocardial infarction (STEMI).

Background: There are limited data for the safety and effectiveness of DES in STEMI.

Methods: We retrospectively analyzed 812 consecutive patients treated with DES implantation for STEMI. Intracoronary thrombus burden was angiographically estimated and categorized as large thrombus burden (LTB), defined as thrombus burden 2 vessel diameters, and small thrombus burden (STB) to predict clinical outcomes. Major adverse cardiac events (MACE) were defined as death, repeat myocardial infarction, and IRA reintervention.

Results: Mean duration of follow-up was 18.2 ± 7.8 months. Large thrombus burden was an independent predictor of mortality (hazard ratio [HR] 1.76, p = 0.023) and MACE (HR 1.88, p = 0.001). The cumulative angiographic IRA-ST was 1.1% at 30 days and 3.2% at 2 years, and continued to augment beyond 2 years. It was significantly higher in the LTB compared with the STB group (8.2% vs. 1.3% at 2 years, respectively, p < 0.001). Significant independent predictors for IRA-ST were LTB (HR 8.73, p < 0.001), stent thrombosis at presentation (HR 6.24, p = 0.001), bifurcation stenting (HR 4.06, p = 0.002), age (HR 0.55, p = 0.003), and rheolytic thrombectomy (HR 0.11, p = 0.03).

Conclusions: Large thrombus burden is an independent predictor of MACE and IRA-ST in patients treated with DES for STEMI.

Abbreviations and Acronyms   BMS = bare-metal stent(s)   DES = drug-eluting stent(s)   IRA-ST = infarct-related artery stent thrombosis   LTB = large thrombus burden   MACE = major adverse cardiac events   MI = myocardial infarction   PES = paclitaxel-eluting stents   PCI = percutaneous coronary intervention   RT = rheolytic thrombectomy   SES = sirolimus-eluting stent(s)   STB = small thrombus burden   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombosis In Myocardial Infarction   TLR = target lesion revascularization (of the infarct-related artery)   TVR = target vessel revascularization (of the infarct-related artery)

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