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Thromb Haemost 2013; 110(04): 826-833
DOI: 10.1160/TH13-02-0092
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

Time course, predictors and clinical implications of stent thrombosis following primary angioplasty

Insights from the DESERT cooperation
Giuseppe De Luca
1   Division of Cardiology, Ospedale “Maggiore della Caritá”, Eastern Piedmont University, Novara, Italy
2   Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy
,
Maurits T. Dirksen
3   Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
,
Christian Spaulding
4   European Hospital Georges Pompidou, Assistance Publique-Hopiteaux de Paris and INSERM U 970, Paris Descartes University, Paris, France
,
Henning Kelbæk
5   The Heart Center, Rigshospitalet, Copenhagen, Denmark
,
Martin Schalij
6   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
,
Leif Thuesen
7   Cardiac Department, Skejby Hospital, Skejby, Denmark
,
Bas van der Hoeven
6   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
,
Marteen A. Vink
3   Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
,
Christoph Kaiser
8   Department of Cardiology, University Hospital Basel, Switzerland
,
Carmine Musto
9   Division of Cardiology, San Camillo Hospital, Rome Italy
,
Tania Chechi
10   Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy
,
Gaia Spaziani
10   Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy
,
Luis Salvador Diaz de la Llera
11   Hemodynamics and Interventional Cardiology Unit, University Hospital Virgen del Rocio, Seville, Spain
,
Vincenzo Pasceri
12   Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
,
Emilio Di Lorenzo
13   Division of Cardiology, “S.G. Moscati”, Avellino, Italy
,
Roberto Violini
9   Division of Cardiology, San Camillo Hospital, Rome Italy
,
Harry Suryapranata
14   Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands
,
Gregg W. Stone
15   Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York, USA
,
for the DESERT cooperation › Author Affiliations
Further Information

Publication History

Received: 03 February 2013

Accepted after major revision: 17 May 2013

Publication Date:
01 December 2017 (online)

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summary

Primary percutaneous coronary intervention (pPCI) has improved survival as compared to thrombolysis. Concerns still remain regarding the risk of stent thrombosis in the setting of STEMI, especially after drugeluting stent (DES) implantation. Therefore, the aim of this study was to report on the timing of stent thrombosis (ST) with both DES and bare metal stents (BMS) and its prognostic significance in patients undergoing pPCI. The Drug-Eluting Stent in Primary Angioplasty (DESERT) cooperation is based on a pooled database including individual data of randomised trials that evaluate the long-term safety and effectiveness of DES as compared to BMS in patients undergoing pPCI for STEMI. Follow-up data were collected for 3–6 years after the procedure. ST was defined as definite or probable, based on the ARC definition. The study population consists of 6,274 STEMI patients undergoing primary angioplasty with BMS or DES. At 1201±440 days, ST occurred in 267 patients (4.25%). Most of the events were acute or subacute (within 30 days) and very late (> 1 years), with different distribution between DES vs BMS. Patients with ST were more often diabetic (21.7% vs 15.1%, p=0.005), more frequently had post-procedural TIMI 0–2 flow (14.0% vs 9.3%, p = 0.01), and were less often treated with dual antiplatelet therapy at one year follow-up. Diabetes (p = 0.036), post-procedural TIMI 0–2 Flow (p = 0.013) and ischaemia time > 6 hours (p = 0.03) were independent predictors of ST. Post-procedural TIMI 0–2 flow (p = 0.001) and ischaemia time > 6 hours (p < 0.001) were independent predictors of early ST, ischaemia time > 6 hours (p=0.05) was independent predictor of late ST, whereas diabetes (p = 0.022) and use of DES (p=0.002) were independent predictors of very late ST. ST was associated with a significantly higher mortality (23.6% vs 6%, p < 0.001). The greatest impact on mortality was observed with subacute (40.4%) and late (20.9%) ST, as compared to acute (12.5%) and very late (9.1%) ST. ST was an independent predictor of mortality (HR [95%CI]=3.73 [2.75–5.07], p < 0.001). In conclusion, ST occurs relatively frequently also beyond the first year for up to six years after pPCI in STEMI, with higher late occurrence rates among patients treated with first generation DES. ST after pPCI is a powerful predictor of mortality, especially subacute ST.

Keywords

Acute myocardial infarction - thrombosis - clinical studies

 

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