TY - JOUR
T1 - Incidence and predictors of coronary stent thrombosis
T2 - Evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses
AU - D'Ascenzo, Fabrizio
AU - Bollati, Mario
AU - Clementi, Fabrizio
AU - Castagno, Davide
AU - Lagerqvist, Bo
AU - De La Torre Hernandez, Jose M.
AU - Ten Berg, Juriën M.
AU - Brodie, Bruce R.
AU - Urban, Philip
AU - Jensen, Lisette Okkels
AU - Sardi, Gabriel
AU - Waksman, Ron
AU - Lasala, John M.
AU - Schulz, Stefanie
AU - Stone, Gregg W.
AU - Airoldi, Flavio
AU - Colombo, Antonio
AU - Lemesle, Gilles
AU - Applegate, Robert J.
AU - Buonamici, Piergiovanni
AU - Kirtane, Ajay J.
AU - Undas, Anetta
AU - Sheiban, Imad
AU - Gaita, Fiorenzo
AU - Sangiorgi, Giuseppe
AU - Modena, Maria Grazia
AU - Frati, Giacomo
AU - Biondi-Zoccai, Giuseppe
N1 - Funding Information:
Dr. Biondi-Zoccai has received research support from Eli Lilly, has consulted for Abbott Vascular, Cordis and Medtronic, has lectured for AstraZeneca, Boston Scientific, Bristol Myers Squibb, Chiesi, Medtronic, Sanofi Aventis and The Medicine Company, and has received career grant support from Medtronic.
Funding Information:
Dr. Applegate has served as a member for, has received research support from, and has received honoraria from Abbott Vascular and St Jude Medical. Dr. Biondi-Zoccai has received research support from Eli Lilly, has consulted for Abbott Vascular, Cordis and Medtronic, has lectured for AstraZeneca, Boston Scientific, Bristol Myers Squibb, Chiesi, Medtronic, Sanofi Aventis and The Medicine Company, and has received career grant support from Medtronic. Dr. Stone has served as a member of the scientific advisory board and has received honoraria from Abbott Vascular and Boston Scientific, and has consulted for AstraZeneca, Bristol Myers Squibb, Eli Lilly, Medtronic, and Merck. Dr. Urban has consulted for Biosensors and Cordis and has lectured for Medtronic and Terumo. Dr. Okkel Jensen consulted for Abbott Vascular and Cordis.
PY - 2013/7/31
Y1 - 2013/7/31
N2 - 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. 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. 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.
AB - 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. 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. 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.
KW - Coronary artery disease
KW - Drug-eluting stent
KW - Meta-analysis
KW - Stent
KW - Stent thrombosis
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=84879077947&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2012.01.080
DO - 10.1016/j.ijcard.2012.01.080
M3 - Article
C2 - 22360945
AN - SCOPUS:84879077947
SN - 0167-5273
VL - 167
SP - 575
EP - 584
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 2
ER -