Stent thrombosis prognosis


 * Associate Editors-In-Chief: Smita Kohli, M.D.; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview
Stent thrombosis(ST) is associated with a mortality rate of 25%.

Complications Of Stent Thrombosis

 * Recurrence of stent thrombosis
 * Myocardial infarction secondary to stent thrombosis has worse prognosis compared to those who develop MI secondary to thrombus else where in the arteries. Stent thrombosis induced MI have higher incidence of in-hospital major cardiovascular and cerebrovascular adverse events including higher death rates.
 * Death occurs in approximately 25% of patients.

Recurrence of Stent Thrombosis

 * Incidence of recurrent stent thrombosis has been reported as high as 12% at 6-months.


 * 1 year recurrence rate of 4.6% was reported in patients with DES.


 * The Dutch stent thrombosis registry reported a 3 year recurrence rate of stent thombosis of 20.1%.

Myocardial Infarction / Death

 * A sub-analysis of TRITON-TIMI 38 study showed that stent thrombosis was associated with death or myocardial infarction in 89% (186/210) of patients . In follow up studies after stent thrombosis, recurrent stent thrombosis has also been noticed, especially during the following six months.


 * Van Werkum et al studied the long term outcome after definite stent thrombosis (ST). 431 patients with definite stent thrombosis were enrolled in this multicenter registry. The primary end point was the composite of cardiac death and definite recurrent ST. The primary end point occurred in 111 patients after a median follow-up of 27.1 months. Clinical outcome was not affected by the type of previously implanted stent (drug-eluting stent or bare-metal stent) or the category of ST (early versus late). Authors concluded that the long-term clinical outcome after a first definite ST is unfavorable, with a high mortality and recurrence rate. Diabetes mellitus, left ventricular ejection fraction < 45%, long total stent length, complex coronary lesions, TIMI flow grade < 3 after percutaneous coronary intervention, and implantation of an additional coronary stent during the emergent percutaneous coronary intervention for the ST were associated with this unfavorable outcome.


 * A pooled analysis of multicenter coronary stent clinical trials showed that in patients with angiographic stent thrombosis the incidence of death or myocardial infarction was 64.4% at the time of stent thrombosis and had a 6-month mortality rate of 8.9%.


 * One year mortality rate was 16% and stent thrombosis recurrence was 4.6% in a multicenter study in Spain.


 * The mortality rate was 31% and MI was seen in 83% of patients with stent thrombosis at 4 years follow-up in a pooled analysis.


 * In a study to investigate the efficacy and outcome of emergency percutaneous coronary interventions (PCI) in patients with stent thrombosis, 6 month major adverse clinical events were comprised of death (11%), reinfarction (16%), and recurrent stent thrombosis (12%).