Author + information
- Received February 6, 2012
- Revision received May 21, 2012
- Accepted June 21, 2012
- Published online October 1, 2012.
- Bruce Brodie, MD⁎,⁎ (, )
- Yashashwi Pokharel, MD†,
- Ankit Garg, MD†,
- Grace Kissling, PhD‡,
- Charles Hansen, MA†,
- Sally Milks, RN⁎,
- Michael Cooper, MD⁎,
- Christopher McAlhany, MD⁎ and
- Tom Stuckey, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Bruce R. Brodie, Moses H. Cone Memorial Hospital, The LeBauer Cardiovascular Research Foundation, 313 Meadowbrook Terrace, Greensboro, North Carolina 27408
Objectives The purpose of this study was to evaluate the frequency and predictors of stent thrombosis (ST) after stenting for ST-segment elevation myocardial infarction (STEMI).
Background Stent thrombosis remains a major concern with STEMI patients treated with primary percutaneous coronary intervention.
Methods Consecutive patients (N = 1,640) undergoing stenting for STEMI were prospectively enrolled in our database and followed for 1 to 15 years. Bare-metal stents were implanted from 1995 to 2002, and drug-eluting and bare-metal stents were implanted from 2003 to 2009. Stent thrombosis was defined as definite or probable.
Results Our population had a high risk profile, including a high incidence of Killip class III to IV (11.5%) and STEMI due to ST (10.2%). Stent thrombosis occurred in 124 patients, including 42 with early ST (0 to 30 days), 35 with late ST (31 days to 1 year), and 47 with very late ST (>1 year). The frequency of ST was 2.7% at 30 days, 5.2% at 1 year, and 8.3% at 5 years. Independent predictors of early or late ST were STEMI due to ST (hazard ratio [HR]: 4.38, 95% confidence interval [CI]: 2.27 to 8.45), small stent size (HR: 2.44, 95% CI: 1.49 to 4.00), Killip class III to IV (HR: 2.39, 95% CI: 1.30 to 4.40), and reperfusion time ≤2 h (HR: 2.09, 95% CI: 1.03 to 4.24). Drug-eluting stent was the only independent predictor of very late ST (HR: 3.73, 95% CI: 1.81 to 7.88).
Conclusions Stent thrombosis after primary percutaneous coronary intervention is relatively frequent and continues to increase out to 5 years. New strategies are needed to prevent ST in STEMI patients, and targeted therapies are needed in patients identified at highest risk.
This study was supported by an unrestricted grant from the LeBauer Charitable Research Foundation and by the Intramural Research Program of the National Institutes of Health, National Institute of Environmental Health Sciences (Z01ES045005). Dr. Brodie has served on the Speakers' Bureau for the Medicines Company and Medrad/Possis. Dr. Stuckey has served as consultant to and on the Speakers' Bureau and on the Advisory Board for Boston Scientific Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 6, 2012.
- Revision received May 21, 2012.
- Accepted June 21, 2012.
- American College of Cardiology Foundation