LETTER TO THE EDITOR
Reply
Peter Berger, MD
Mayo Clinic, Department of Cardiology, 200 First Street SW, Rochester, Minnesota 55905-0001, USA
berger.peter{at}mayo.edu
We appreciate the comments and acknowledge the concerns of Dr. Martínez-Sellés regarding the diagnosis of stent thrombosis in our analysis of the Mayo Clinic registry (1). It may be quite reasonably argued that a definitive diagnosis of stent thrombosis requires angiographic confirmation, perhaps with even angioscopic evidence of thrombus, or autopsy (2). If this had been feasible, it is likely that a number of cases that we considered to represent stent thrombosis would not have been attributable to thrombotic occlusion within the stent. Similarly, although stent thrombosis is a highly morbid event that results in Q-wave infarction and death in the majority of cases, it is also possible that some cases of stent thrombosis might have occurred subclinically and been missed in our analysis.
However, our interest in this pathologic entity arises primarily from the clinical sequelae of this complication. Therefore, we considered all patients to have had stent thrombosis when it was confirmed angiographically, when a myocardial infarction (MI) (ST- or non–ST segment elevation) occurred in the territory of the treated vessel and stent thrombosis could not be definitively excluded, or when death was sudden and unexplained, a definition that has been widely used by others (3–9). Therefore, although Dr. Martínez-Sellés is correct that we may have both included some cases not due to stent thrombosis and missed some that were, such a definition using "hard" end points is both practical and allows for sensible comparisons of preventative and therapeutic strategies, and we believed it would be most suitable for this study of frequency and correlates of this complication of percutaneous coronary intervention.
Finally, we must thank Dr. Martínez-Sellés for allowing us to clarify the outcomes associated with stent thrombosis in our population. There were in fact three cases of stent thrombosis without MI or death that were diagnosed by coronary angiography, not one. We apologize for this error.
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References
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