Advertisement

Incidence of Coronary Stent Thrombosis Based on Academic Research Consortium Definitions

      Stent thrombosis occurs infrequently after drug-eluting stent (DES) placement, but concerns have surfaced that identification of stent thrombosis based solely on angiography may underestimate the true incidence of this complication. The purpose of this study was to compare rates of stent thrombosis using Academic Research Consortium (ARC) definitions. From April 2002 to February 2005, bare-metal stents (BMSs) and DESs were placed at Wake Forest University Baptist Medical Center. Rates of ARC definite, probable, and possible stent thrombosis were evaluated. Overall, definite stent thrombosis occurred in 1.4% of BMSs and 1.1% of DESs (p = 0.47); probable stent thrombosis, in 1.0% of BMSs and 0.9% of DESs (p = 0.81); definite plus probable stent thrombosis, in 2.3% of BMSs and 1.9% of DESs (p = 0.48); and possible stent thrombosis, in 6.8% of BMSs and 3.5% of DESs (p <0.001). Rates of definite late (31 days to 1 year) and very late (>1 year) stent thrombosis were 0.9% for BMSs and 0.06% for DESs (p <0.001) and 0.16% for BMSs and 0.56% for DESs, respectively (p = 0.13). Rates of definite plus probable and late and very late stent thrombosis were 1.1% for BMSs and 0.19% for DESs (p <0.001) and 0.40% for BMSs and 0.68% for DESs, respectively (p = 0.31). Rates of possible stent thrombosis increased significantly for each thrombosis interval. In conclusion, rates of stent thrombosis using the proposed ARC definition differed by stent type, definition of stent thrombosis, and thrombosis interval. Use of the ARC probable stent thrombosis paralleled rates of definite stent thrombosis alone, but partially masked the occurrence of late (>1 year) stent thrombosis in DESs compared with BMSs.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Moses J.W.
        • Leon M.B.
        • Popma J.J.
        • Fitzgerald P.J.
        • Holmes D.R.
        • O'Shaughnessy C.
        • Caputo R.P.
        • Kereiakes D.J.
        • Williams D.O.
        • Teirstein P.S.
        • Jaeger J.L.
        • Kuntz R.E.
        • SIRIUS Investigators
        Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery.
        N Engl J Med. 2003; 349: 1315-1323
        • Stone G.W.
        • Ellis S.G.
        • Cox D.A.
        • Hermiller J.
        • O'Shaughnessy C.
        • Mann J.T.
        • Turco M.
        • Caputo R.
        • Bergin P.
        • Greenberg J.
        • Popma J.J.
        • Russell M.E.
        • TAXUS-IV Investigators
        One-year clinical results with the slow-release, polymer-based, paclitaxel-eluting TAXUS stent: the TAXUS-IV Trial.
        Circulation. 2004; 109: 1942-1947
        • Pfisterer M.
        • Brunner-La Rocca H.P.
        • Buser P.T.
        • Rickenbacher P.
        • Hunziker P.
        • Mueller C.
        • Jeger R.
        • Bader F.
        • Osswald S.
        • Kaiser C.
        • BASKET-LATE Investigators
        Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents.
        J Am Coll Cardiol. 2006; 48: 2584-2591
        • Bavry A.A.
        • Kumbhani D.J.
        • Helton T.J.
        • Borek P.P.
        • Mood G.R.
        • Bhatt D.L.
        Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials.
        Am J Med. 2006; 119: 1056-1061
        • Lagerqvist B.
        • James S.K.
        • Stenestrand U.
        • Lindback J.
        • Nilsson T.
        • Wallentin L.
        • SCAAR Study Group
        Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden.
        N Engl J Med. 2007; 356: 1009-1019
        • Mauri L.
        • Hsieh W.H.
        • Massaro J.M.
        • Ho K.K.L.
        • D'Agostino R.
        • Cutlip D.E.
        Stent thrombosis in randomized clinical trials of drug-eluting stents.
        N Engl J Med. 2007; 356: 1020-1029
        • Applegate R.J.
        • Sacrinty M.T.
        • Kutcher M.A.
        • Baki T.T.
        • Gandhi S.K.
        • Santos R.M.
        • Little W.C.
        Comparison of drug-eluting versus bare metal stents on later frequency of acute myocardial infarction and death.
        Am J Cardiol. 2007; 99: 333-338
        • Applegate R.J.
        • Sacrinty M.T.
        • Kutcher M.A.
        • Santos R.M.
        • Gandhi S.K.
        • Baki T.T.
        • Little W.C.
        • et al.
        “Off-label” stent therapy—2 year comparison of drug-eluting versus bare metal stents.
        J Am Coll Cardiol. 2008; 51: 607-614
        • American College of Cardiology
        National Cardiovascular Data Registry Module Version 3.0. 2004.
        (Accessed October 1, 2007)
        • Eisenstein E.L.
        • Anstrom K.J.
        • Kong D.F.
        • Shaw L.K.
        • Tuttle R.H.
        • Mark D.B.
        • Kramer J.M.
        • Harrington R.A.
        • Matchar D.B.
        • Kandzari D.E.
        • et al.
        Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation.
        JAMA. 2007; 297: 159-168
        • Hodgson J.M.
        • Stone G.W.
        • Lincoff A.M.
        • Klein L.
        • Walpole H.
        • Bottner R.
        • Weiner B.H.
        • Leon M.B.
        • Feldman T.
        • Babb J.
        • Dehmer G.J.
        Late stent thrombosis: considerations and practical advice for the use of drug-eluting stents: a report from the Society for Cardiovascular Angiography and Interventions Drug-Eluting Stent Task Force.
        Cathet Cardiovasc Intervent. 2007; 69: 327-333
        • Hearne S.E.
        • Amsterdam P.B.
        • Baker W.A.
        • Sawchak S.R.
        • Phillips H.R.
        • Sketch Jr., M.H.
        • Zidar J.P.
        Diagnosing coronary arterial stent thrombosis and arterial closure.
        Am J Cardiol. 1998; 82: 666-668
        • Haude M.
        • Erbel R.
        • Issa H.
        • Straub U.
        • Rupprecht H.J.
        • Treese N.
        • Meyer J.
        Subacute thrombotic complications after intracoronary implantation of Palmaz-Schatz stents.
        Am Heart J. 1993; 126: 15-22
        • Little W.C.
        • Constantinescu M.
        • Applegate R.J.
        • Kutcher M.A.
        • Burrows M.T.
        • Kahl F.R.
        • Santamore W.P.
        Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild to moderate coronary artery disease?.
        Circulation. 1988; 78: 1157-1166