JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
 QUICK SEARCH:   [advanced]


     


J Am Coll Cardiol, 2008; 51:986-990, doi:10.1016/j.jacc.2007.10.057
© 2008 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow View CVN News Brief
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Google Scholar
Right arrow Articles by de la Torre-Hernández, J. M.
PubMed
Right arrow Articles by de la Torre-Hernández, J. M.
Related Collections
Right arrowRelated Article

CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Drug-Eluting Stent Thrombosis

Results From the Multicenter Spanish Registry ESTROFA (Estudio ESpañol sobre TROmbosis de stents FArmacoactivos)

José M. de la Torre-Hernández, MD, PhD*,*, Fernando Alfonso, MD, PhD{dagger}, Felipe Hernández, MD{ddagger}, Jaime Elizaga, MD§, Marcelo Sanmartin, MD, PhD||, Eduardo Pinar, MD, Iñigo Lozano, MD, PhD#, Jose M. Vazquez, MD**, Javier Botas, MD, PhD{dagger}{dagger}, Armando Perez de Prado, MD{ddagger}{ddagger}, Jose M. Hernández, MD, PhD§§, Juan Sanchis, MD, PhD||||, Juan M. Ruiz Nodar, MD, PhD¶¶, Alfredo Gomez-Jaume, MD, PhD##, Mariano Larman, MD***, Jose A. Diarte, MD, PhD{dagger}{dagger}{dagger}, Javier Rodríguez-Collado, MD{ddagger}{ddagger}{ddagger}, Jose R. Rumoroso, MD, PhD§§§, Jose R. Lopez-Minguez, MD||||||, Josepa Mauri, MD¶¶¶ for the ESTROFA Study Group

* Hospital Marques de Valdecilla, Santander, Spain
{dagger} Hospital Clinico San Carlos, Madrid, Spain
{ddagger} Hospital 12 de Octubre, Madrid, Spain
§ Hospital Gregorio Marañon, Madrid, Spain
|| Hospital do Meixoeiro, Vigo, Spain
Hospital Virgen de la Arrixaca, Murcia, Spain
# Hospital Central de Asturias, Oviedo, Spain
** Hospital Juan Canalejo, La Coruña, Spain
{dagger}{dagger} Hospital Fundación Alcorcon, Alcorcon, Spain
{ddagger}{ddagger} Hospital de Leon, Leon, Spain
§§ Hospital Virgen de la Victoria, Malaga, Spain
|||| Hospital Clínico, Valencia, Spain
¶¶ Hospital General, Alicante, Spain
## Hospital Son Dureta, Palma de Mallorca, Spain
*** Policlínica Guipúzcoa, San Sebastián, Spain
{dagger}{dagger}{dagger} Hospital Miguel Servet, Zaragoza, Spain
{ddagger}{ddagger}{ddagger} Hospital Clinico, Salamanca, Spain
§§§ Hospital de Galdacano, Bilbao, Spain
|||||| Hospital Infanta Cristina, Badajoz, Spain
¶¶¶ Hospital Germans Trias i Pujol, Badalona, Spain.

Manuscript received July 16, 2007; revised manuscript received October 17, 2007, accepted October 22, 2007.

* Reprint requests and correspondence: Dr. José M. de la Torre Hernández, Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain. (Email: he1thj{at}humv.es).

Objectives: This study sought to assess the incidence, predictors, and outcome of drug-eluting stent (DES) thrombosis in real-world clinical practice.

Background: The DES thromboses in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications.

Methods: We designed a large-scale, nonindustry-linked multicentered registry, with 20 centers in Spain. The participant centers provided follow-up data for their patients treated with DES, reporting a detailed standardized form in the event of any angiography-documented DES-associated thrombosis occurring.

Results: Of 23,500 patients treated with DES, definite stent thrombosis (ST) developed in 301: 24 acute, 125 subacute, and 152 late. Of the late, 62 occurred >1 year (very late ST). The cumulative incidence was 2% at 3 years. Antiplatelet treatment had been discontinued in 95 cases (31.6%). No differences in incidences were found among stent types. Independent predictors for subacute ST analyzed in a subgroup of 14,120 cases were diabetes, renal failure, acute coronary syndrome, ST-segment elevation myocardial infarction, stent length, and left anterior descending artery stenting, and for late ST were ST-segment elevation myocardial infarction, stenting in left anterior descending artery, and stent length. Mortality at 1-year follow-up was 16% and ST recurrence 4.6%. Older age, left ventricular ejection fraction <45%, nonrestoration of Thrombolysis In Myocardial Infarction flow grade 3, and additional stenting were independent predictors for mortality.

Conclusions: The cumulative incidence of ST after DES implantation was 2% at 3 years. No differences were found among stent types. Patient profiles differed between early and late ST. Short-term prognosis is poor, especially when restoration of normal flow fails.

Abbreviations and Acronyms
  BMS = bare-metal stent(s)
  DES = drug-eluting stent(s)
  LAD = left anterior descending artery
  PES = paclitaxel-eluting stent(s)
  SES = sirolimus-eluting stent(s)
  ST = stent thrombosis
  STEMI = ST-segment elevation myocardial infarction


Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 51: A26. [Full Text] [PDF]



This article has been cited by other articles:


Home page
J Am Coll CardiolHome page
F. Alfonso
The "vulnerable" stent why so dreadful?
J. Am. Coll. Cardiol., June 24, 2008; 51(25): 2403 - 2406.
[Full Text] [PDF]




HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 2008 by the American College of Cardiology Foundation.