Author + information
- Received August 23, 2011
- Accepted September 3, 2011
- Published online January 1, 2012.
- Ehrin J. Armstrong, MD⁎,
- Khung Keong Yeo, MBBS⁎,
- Usman Javed, MD⁎,
- Ehtisham Mahmud, MD†,
- Mitul Patel, MD†,
- Kendrick A. Shunk, MD‡,§,
- John S. MacGregor, MD, PhD‡∥,
- Reginald I. Low, MD⁎ and
- Jason H. Rogers, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Jason H. Rogers, University of California, Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, California 95817
Objectives This study sought to describe the presentation, management, and outcomes of patients presenting with angiographic definite stent thrombosis (ST) at coronary bifurcations.
Background The development of drug-eluting stents has made it increasingly feasible to treat bifurcation lesions percutaneously. However, ST at coronary bifurcations may be associated with greater mortality than ST elsewhere.
Methods We analyzed a multicenter California registry comprising all cases of angiographic definite ST at 5 academic hospitals from 2005 to 2010. Stenting was defined as occurring at a bifurcation if the main vessel stent crossed a side branch ≥2.0 mm in diameter (provisional single-stent approach), or if there was a prior 2-stent bifurcation approach.
Results Among 173 cases of angiographic definite ST, we identified 20 cases of ST at coronary bifurcations. Nine of 20 bifurcation ST (45%) occurred with a stent present in both the parent and branch vessel. Eight cases had thrombus present in both the parent and side branch vessels. In-hospital mortality was much higher for subjects with bifurcation ST than ST at a nonbifurcation site (20% vs. 2%, p < 0.0001). During a median follow-up of 2.3 years, ST at a coronary bifurcation was associated with increased long-term mortality (hazard ratio [HR]: 3.3, 95% confidence interval [CI]: 1.4 to 7.7, p = 0.007) and a significantly higher risk for major adverse cardiovascular events (HR: 2.2, 95% CI: 1.04 to 4.8, p = 0.04) relative to ST at a nonbifurcation site.
Conclusions ST at coronary bifurcations is associated with a higher in-hospital and long-term mortality than ST at nonbifurcation lesions. (Stent Thrombus in Acute Coronary Syndromes; NCT00931502)
Dr. Mahmud serves on the Speaker's Bureau for Medtronic and Eli Lilly; is a consultant for Eli Lilly; and receives research support from Boston Scientific, Abbott Vascular, Accumetrics, and sanofi-aventis. Dr. Low is on the advisory board of and is a consultant for Abbott Vascular and Boston Scientific. Dr. Rogers is a consultant for Volcano, Medtronic, and Boston Scientific. All other authors have reported that they have relationships relevant to the contents of this paper to disclose.
- Received August 23, 2011.
- Accepted September 3, 2011.
- American College of Cardiology Foundation