Incidence, predictors and outcome of thrombosis after succesful implantation of drug-eluting stents

Ioannis Iakovou, Thomas Schmidt, Erminio Bonizzoni, Lei Ge, Giuseppe M. Sangiorgi, Goran Stankovic, Flavio Airoldi, Alaide Chieffo, Matteo Montorfano, Mauro Carlino, Iassen Michev, Nicola Corvaja, Carlo Briguori, Ulrich Gerckens, Eberhard Grube, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

Context: Traditionally, stent thrombosis has been regarded as a complication of percutaneous coronary interventions during the first 30 postprocedural days. However, delayed endothelialization associated with the implantation of drug-eluting stents may extend the risk of thrombosis beyond 30 days. Data are limited regarding the risks and the impact of this phenomenon outside clinical trials. Objective: To evaluate the incidence, predictors, and clinical outcome of stent thrombosis after implantation of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice. Design, Setting, and Patients: Prospective observational cohort study conducted at 1 academic hospital and 2 community hospitals in Germany and Italy. A total of 2229 consecutive patients underwent successful implantation of sirolimus-eluting (1062 patients, 1996 lesions, 2272 stents) or paclitaxel-eluting (1167 patients, 1801 lesions, 2223 stents) stents between April 2002 and January 2004. Interventions: Implantation of a drug-eluting stent (sirolimus or paclitaxel). All patients were pretreated with ticlopidine or clopidogrel and aspirin. Aspirin was continued indefinitely and clopidogrel or ticlopidine for at least 3 months after sirolimus-uting and for at least 6 months after paclitaxel-eluting stent implantation. Main Outcome Measures: Subacute thrombosis (from procedure end through 30 days), late thrombosis (>30 days), and cumulative stent thrombosis. Results: At 9-month follow-up, 29 patients (1.3%) had stent thrombosis (9 [0.8%] with sirolimus and 20 [1.7%] with paclitaxel; P = .09). Fourteen patients had subacute thrombosis (0.6%) and 15 patients had late thrombosis (0.7%). Among these 29 patients, 13 died (case fatality rate, 45%). Independent predictors of stent thrombosis were premature antiplatelet therapy discontinuation (hazard ratio [HR], 89.78; 95% Cl, 29.90-269.60; P

Original languageEnglish
Pages (from-to)2126-2130
Number of pages5
JournalJournal of the American Medical Association
Volume293
Issue number17
DOIs
Publication statusPublished - May 4 2005

ASJC Scopus subject areas

  • Medicine(all)

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    Iakovou, I., Schmidt, T., Bonizzoni, E., Ge, L., Sangiorgi, G. M., Stankovic, G., Airoldi, F., Chieffo, A., Montorfano, M., Carlino, M., Michev, I., Corvaja, N., Briguori, C., Gerckens, U., Grube, E., & Colombo, A. (2005). Incidence, predictors and outcome of thrombosis after succesful implantation of drug-eluting stents. Journal of the American Medical Association, 293(17), 2126-2130. https://doi.org/10.1001/jama.293.17.2126