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Aoki J, Lansky AJ, Mehran R, Moses J, Bertrand ME, McLaurin BT, Cox DA, Lincoff AM, Ohman EM, White HD, Parise H, Leon MB, Stone GW. Early Stent Thrombosis in Patients With Acute Coronary Syndromes Treated With Drug-Eluting and Bare Metal Stents. Circulation 2009; 119:687-98. [PMID: 19171852 DOI: 10.1161/circulationaha.108.804203] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The clinical and angiographic predictors of early (<30 days) stent thrombosis (ST) have not been reported in high-risk patients with acute coronary syndromes.
Methods and Results—
Qualitative and quantitative coronary angiographic analyses were performed in 3405 patients with moderate- and high-risk acute coronary syndromes in whom stents were implanted in the prospective randomized Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial, including 3043 patients (89.4%) in whom drug-eluting stents were implanted. Within 30 days, definite or probable ST occurred in 48 patients (1.4%). ST rates were not significantly different in patients treated with bare metal stents compared with drug-eluting stents (1.4% versus 1.4%;
P
=1.00) or with heparin plus glycoprotein IIb/IIIa inhibitors (1.1%) compared with bivalirudin with or without IIb/IIIa inhibitors (1.6% and 1.5%, respectively;
P
=0.26 and
P
=0.37, respectively). Compared with patients without ST, patients with ST more frequently had insulin-requiring diabetes mellitus and baseline renal insufficiency, a greater overall burden of coronary atherosclerosis, and suboptimal final angiographic results. ST also was more common in patients without preprocedural thienopyridine administration and with inconsistent antiplatelet drug use within 30 days. By multivariable analysis, the strongest independent predictors of definite ST were a smaller final stent minimal lumen diameter, a lack of preprocedural thienopyridine administration, the extent of coronary artery disease, and higher baseline hemoglobin level.
Conclusions—
Occurring in nearly 1 in 70 patients, early ST is relatively common in acute coronary syndromes, occurs with similar frequency after anticoagulation with either heparin plus glycoprotein IIb/IIIa inhibitors or bivalirudin with or without IIb/IIIa inhibitors, and is predicted by diffuse atherosclerosis, suboptimal angiographic results, and inadequate pharmacotherapy.
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Affiliation(s)
- Jiro Aoki
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - Alexandra J. Lansky
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - Roxana Mehran
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - Jeffery Moses
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - Michel E. Bertrand
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - Brent T. McLaurin
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - David A. Cox
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - A. Michael Lincoff
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - E. Magnus Ohman
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - Harvey D. White
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - Helen Parise
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - Martin B. Leon
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
| | - Gregg W. Stone
- From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (J.A., A.J.L., R.M., J.M., H.P., M.B.L., G.W.S.); Hôpital Cardiologique, Lille, France (M.E.B.); AnMed Health, Anderson, SC (B.T.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Cleveland Clinic, Cleveland, Ohio (A.M.L.); Duke University Medical Center, Durham, NC (E.M.O.); and Auckland City Hospital, Auckland, New Zealand (H.D.W.)
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