Risk Factors and Long-Term Clinical Outcomes of Second-Generation Drug-Eluting Stent Thrombosis.

Background The risk factors and long-term clinical outcomes of patients with definite stent thrombosis (ST) after second-generation drug-eluting stent (DES) implantation have not yet been adequately assessed. Methods and Results The REAL-ST (Retrospective Multicenter Registry of ST After First- and Second-Generation DES Implantation) included 313 definite ST of second-generation DES (early ST, n=179; late ST, n=66; very late ST, n=68). Four patients without definite ST of second-generation DES were identified as control patients for each ST case. Risk factors of definite ST were mostly different according to the timing of ST: ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina at presentation, current smoking, left ventricular ejection fraction <40%, prior percutaneous coronary intervention, stent overlap, severely calcified lesion, left main coronary artery lesion, proximal left anterior descending lesion, postdiameter stenosis ≥20%, for early ST; age <70 years, ST-segment-elevation myocardial infarction at presentation, hemodialysis, left ventricular ejection fraction <40%, in-stent restenosis, and severely calcified lesion for late ST; and proximal left anterior descending lesion and in-stent restenosis for very late ST. Cumulative 4-year incidence of death after the index ST events was significantly higher in the ST patients than control patients (33.0% versus 12.3%, P<0.001 for early ST versus control; 30.6% versus 14.2%, P<0.001 for late ST versus control; and 28.0% versus 13.0%, P<0.001 for very late ST versus control, respectively). Conclusions Risk factors of definite ST after second-generation DES implantation were mostly different according to the timing of ST. Definite ST patients showed unfavorable long-term clinical outcomes compared with those without definite ST. Clinical Trial Registration URL: https://www.umin.ac.jp . Unique identifier: UMIN000025181.

[1]  G. Stone,et al.  Percutaneous coronary intervention of lesions with in‐stent restenosis: A report from the ADAPT‐DES study , 2017, American heart journal.

[2]  A. Lotfi,et al.  Stent Thrombosis , 2017, Seminars in Thrombosis and Hemostasis.

[3]  W. Desmet,et al.  Optical Coherence Tomography Findings in Patients With Coronary Stent Thrombosis , 2017, Circulation.

[4]  N. Jewell,et al.  Case–control matching: effects, misconceptions, and recommendations , 2017, European Journal of Epidemiology.

[5]  L. Räber,et al.  The association between in-stent neoatherosclerosis and native coronary artery disease progression: a long-term angiographic and optical coherence tomography cohort study. , 2015, European heart journal.

[6]  K. Ando,et al.  Two-Year Clinical Outcomes of Newer-Generation Drug-Eluting Stent Implantation Following Rotational Atherectomy for Heavily Calcified Lesions. , 2015, Circulation journal : official journal of the Japanese Circulation Society.

[7]  T. Adriaenssens,et al.  PREvention of late Stent Thrombosis by an Interdisciplinary Global European effort: PRESTIGE. , 2014, European heart journal.

[8]  E. Tuzcu,et al.  Stent Thrombosis With Second-Generation Drug-Eluting Stents Compared With Bare-Metal Stents: Network Meta-Analysis of Primary Percutaneous Coronary Intervention Trials in ST-Segment–Elevation Myocardial Infarction , 2014, Circulation. Cardiovascular interventions.

[9]  Gary S. Mintz,et al.  Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents: The Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) Study , 2014, Circulation.

[10]  Michael Joner,et al.  Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients. , 2013, JACC. Cardiovascular interventions.

[11]  Peter L Duffy,et al.  Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents: The ADAPT-DES Study , 2013 .

[12]  G. Stone,et al.  Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis. , 2013, Journal of the American College of Cardiology.

[13]  Y. Hayashi,et al.  Very late stent thrombosis and late target lesion revascularization after sirolimus-eluting stent implantation: five-year outcome of the j-Cypher Registry. , 2012, Circulation.

[14]  T. Kume,et al.  Comparisons of Baseline Demographics, Clinical Presentation, and Long-Term Outcome Among Patients With Early, Late, and Very Late Stent Thrombosis of Sirolimus-Eluting Stents: Observations From the Registry of Stent Thrombosis for Review and Reevaluation (RESTART) , 2010, Circulation.

[15]  P. Serruys,et al.  Stent thrombosis. , 2010, Journal of the American College of Cardiology.

[16]  A. V. Van't Hof,et al.  Long-Term Clinical Outcome After a First Angiographically Confirmed Coronary Stent Thrombosis: An Analysis of 431 Cases , 2009, Circulation.

[17]  P. Serruys,et al.  Clinical End Points in Coronary Stent Trials: A Case for Standardized Definitions , 2007, Circulation.

[18]  Michael Joner,et al.  Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. , 2006, Journal of the American College of Cardiology.

[19]  C. Macaya,et al.  Findings of intravascular ultrasound during acute stent thrombosis , 2004, Heart.