Lack of clopidogrel therapy in the first 30 days after PCI was strongly associated with stent thrombosis (HR 36.5; 95% CI 8.0-167.8), along with stent undersizing and malignancy.
Case-Control (n=21,009)
Yes
What are the clinical, angiographic, and procedural predictors of coronary stent thrombosis in patients treated with bare-metal or drug-eluting stents?
Discontinuation of clopidogrel, stent undersizing, malignancy, and intermediate proximal CAD are strong predictors of coronary stent thrombosis, with clopidogrel cessation within 30 days carrying a 36-fold increased risk.
Hazard Ratio: 36.5 (95% CI 8–167.8)
OBJECTIVES: This study sought to comprehensively identify predictors of stent thrombosis (ST). BACKGROUND: Given the devastating consequences of ST, efforts should be directed toward risk stratification to identify patients at highest risk for ST. METHODS: Consecutive patients with angiographic ST were enrolled. Patients who did not suffer from a ST were randomly selected in a 2:1 ratio and were matched for: 1) percutaneous coronary intervention (PCI) indication; 2) same date of index PCI; and 3) same interventional center. RESULTS: Of 21,009 patients treated with either a bare-metal or drug-eluting stent, 437 patients (2.1%) presented with a definite ST. A total of 140 STs were acute, 180 were subacute, 58 were late, and 59 were very late. Undersizing of the coronary stent, Thrombolysis In Myocardial Infarction flow grade or=50% to <70% stenosis) coronary artery disease proximal to the culprit lesion were the strongest predictors of ST.
Werkum et al. (2009) conducted a case-control in Coronary Stent Thrombosis (n=21,009). Lack of clopidogrel therapy vs. Continuation of clopidogrel therapy was evaluated on Stent thrombosis (HR 36.5, 95% CI 8.0-167.8). Lack of clopidogrel therapy in the first 30 days after PCI was strongly associated with stent thrombosis (HR 36.5; 95% CI 8.0-167.8), along with stent undersizing and malignancy.
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