High recurrence rate of stent thrombosis after the first event: Results from the Dutch Stent Thrombosis Registry

March 29, 2008 By Lauren Ciaglo [mailto:lciaglo@perfuse.org]

SCAI-ACCi2 08-Chicago, IL: Results from the Dutch Stent Thrombosis study demonstrate that the implantation of an additional stent during emergency treatment of initial stent thrombosis is among the strongest predictors of recurrent stent thrombosis.

The study was presented today at the SCAI-i2 summit Annual Scientific Sessions in Chicago by Dr. Jochem Wouter van Werkum.

One of the main concerns of using the drug eluting stents is the potential increased risk of late stent thrombosis (ST), which has been attributed to the delayed endothelialization of a drug eluting stent. In addition, a number of factors have been associated with stent thrombosis including premature discontinuation of clopidogrel therapy. The present study investigated the risk of recurrent stent thrombosis among patients who had already suffered an initial episode of stent thrombosis.

The Dutch Stent Thrombosis study included 437 patients who had stent thrombosis confirmed by angiography from January 2004 through February 2007. Data were collected on clinical, angiographic, and procedural characteristics. Dr. van Werkum and colleagues demonstrated that 16.9% of patients (74/437 patients) experienced multiple episodes of stent thrombosis. Of these, 61 had 2 episodes of ST, 12 had 3 episodes, and one patient had four episodes of stent thrombosis.

The investigators identified three independent predictors that were associated with recurrence of stent thrombosis.


 * Additional stent implantation during emergency treatment for the first episode
 * Previous myocardial infarction (MI)
 * Patients with late stent thrombosis (thrombosis developed >30 days after stent implantation).

Those patients who had an additional stent implanted during emergency treatment of the first episode were 4.2 times as likely to experience a repeat episode of stent thrombosis (95% CI 2.3-7.7, p<0.0001). Patients with a prior MI were 2.6 times as likely as other patients to experience repeat stent thrombosis (95% CI 1.5-4.5, p<0.001) and those patients who developed late stent thrombosis were 2.1 times as likely to experience a repeat episode (95% CI 1.2-3.7, p=0.0127).

The results of the Dutch Stent Thrombosis study suggest that further stent implantation for stent thrombosis may be associated with a higher risk of adverse outcomes. Other pharmacotherapeutic strategies might be beneficial in this setting but these strategies would require further evaluation. One of the limitations of the study includes its relatively small number of patients and the fact that this study was not randomized.

Source
Presented at the SCAI Annual Scientific Sessions in partnership with ACC i2 summit, March 29-April 1, 2008 Chicago