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Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses.

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Citation: International Journal of Cardiology. 167(2):575-84, 2013 Jul 31.PMID: 22360945Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Meta-AnalysisSubject headings: *Cooperative Behavior | *Coronary Thrombosis/ep [Epidemiology] | *Drug-Eluting Stents/ae [Adverse Effects] | *Internationality | Coronary Thrombosis/di [Diagnosis] | Coronary Thrombosis/th [Therapy] | Humans | Incidence | Platelet Aggregation Inhibitors/ad [Administration & Dosage] | Predictive Value of Tests | Withholding Treatment/td [Trends]Year: 2013 ISSN:

0167-5273

Name of journal: International journal of cardiologyAbstract: BACKGROUND: Stent thrombosis remains among the most feared complications of percutaneous coronary intervention (PCI) with stenting. However, data on its incidence and predictors are sparse and conflicting. We thus aimed to perform a collaborative systematic review on incidence and predictors of stent thrombosis.CONCLUSIONS: Despite numerous possible risk factors, the most common and consistent predictors of stent thrombosis are early antiplatelet therapy discontinuation, extent of coronary disease, and stent number/length. Copyright 2012 Elsevier Ireland Ltd. All rights reserved.METHODS: PubMed was systematically searched for eligible studies from the drug-eluting stent (DES) era (1/2002-12/2010). Studies were selected if including > 2000 patients undergoing stenting or reporting on > 25 thromboses. Study features, patient characteristics, and incidence of stent thrombosis were abstracted and pooled, when appropriate, with random-effect methods (point estimate [95% confidence intervals]), and consistency of predictors was formally appraised.RESULTS: A total of 30 studies were identified (221,066 patients, 4276 thromboses), with DES used in 87%. After a median of 22 months, definite, probable, or possible stent thrombosis had occurred in 2.4% (2.0%; 2.9%), with acute in 0.4% (0.2%; 0.6%), subacute in 1.1% (1.0%; 1.3%), late in 0.5% (0.4%; 0.6%), and very late in 0.6% (0.4%; 0.8%). Similar figures were computed for studies reporting only on DES. From a total of 47 candidate variables, definite/probable stent thrombosis was more commonly and consistently predicted by early antiplatelet therapy discontinuation, extent of coronary disease, and stent number/length, with acute coronary syndrome at admission, diabetes, smoking status, and bifurcation/ostial disease also proving frequent predictors, but less consistently.All authors: Airoldi F, Applegate RJ, Biondi-Zoccai G, Bollati M, Brodie BR, Buonamici P, Castagno D, Clementi F, Colombo A, D'Ascenzo F, de la Torre Hernandez JM, Frati G, Gaita F, Jensen LO, Kirtane AJ, Lagerqvist B, Lasala JM, Lemesle G, Modena MG, Sangiorgi G, Sardi G, Schulz S, Sheiban I, Stone GW, ten Berg JM, Undas A, Urban P, Waksman RFiscal year: FY2014Digital Object Identifier:

http://dx.doi.org/10.1016/j.ijcard.2012.01.080

Date added to catalog: 2014-04-03

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	22360945	Available		22360945

BACKGROUND: Stent thrombosis remains among the most feared complications of percutaneous coronary intervention (PCI) with stenting. However, data on its incidence and predictors are sparse and conflicting. We thus aimed to perform a collaborative systematic review on incidence and predictors of stent thrombosis.

CONCLUSIONS: Despite numerous possible risk factors, the most common and consistent predictors of stent thrombosis are early antiplatelet therapy discontinuation, extent of coronary disease, and stent number/length. Copyright 2012 Elsevier Ireland Ltd. All rights reserved.

METHODS: PubMed was systematically searched for eligible studies from the drug-eluting stent (DES) era (1/2002-12/2010). Studies were selected if including > 2000 patients undergoing stenting or reporting on > 25 thromboses. Study features, patient characteristics, and incidence of stent thrombosis were abstracted and pooled, when appropriate, with random-effect methods (point estimate [95% confidence intervals]), and consistency of predictors was formally appraised.

RESULTS: A total of 30 studies were identified (221,066 patients, 4276 thromboses), with DES used in 87%. After a median of 22 months, definite, probable, or possible stent thrombosis had occurred in 2.4% (2.0%; 2.9%), with acute in 0.4% (0.2%; 0.6%), subacute in 1.1% (1.0%; 1.3%), late in 0.5% (0.4%; 0.6%), and very late in 0.6% (0.4%; 0.8%). Similar figures were computed for studies reporting only on DES. From a total of 47 candidate variables, definite/probable stent thrombosis was more commonly and consistently predicted by early antiplatelet therapy discontinuation, extent of coronary disease, and stent number/length, with acute coronary syndrome at admission, diabetes, smoking status, and bifurcation/ostial disease also proving frequent predictors, but less consistently.

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