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J Am Coll Cardiol. 2007 Aug 14;50(7):573-83. Epub 2007 Jul 30.

Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden.

Author information

1
Erasmus Medical Center, Department of Interventional Cardiology, Thoraxcenter, Rotterdam, The Netherlands. g.sianos@erasmusmc.nl

Abstract

OBJECTIVES:

This study sought to investigate the impact of thrombus burden on the clinical outcome and angiographic infarct-related artery stent thrombosis (IRA-ST) in patients routinely treated with drug-eluting stent (DES) implantation for ST-segment elevation myocardial infarction (STEMI).

BACKGROUND:

There are limited data for the safety and effectiveness of DES in STEMI.

METHODS:

We retrospectively analyzed 812 consecutive patients treated with DES implantation for STEMI. Intracoronary thrombus burden was angiographically estimated and categorized as large thrombus burden (LTB), defined as thrombus burden > or =2 vessel diameters, and small thrombus burden (STB) to predict clinical outcomes. Major adverse cardiac events (MACE) were defined as death, repeat myocardial infarction, and IRA reintervention.

RESULTS:

Mean duration of follow-up was 18.2 +/- 7.8 months. Large thrombus burden was an independent predictor of mortality (hazard ratio [HR] 1.76, p = 0.023) and MACE (HR 1.88, p = 0.001). The cumulative angiographic IRA-ST was 1.1% at 30 days and 3.2% at 2 years, and continued to augment beyond 2 years. It was significantly higher in the LTB compared with the STB group (8.2% vs. 1.3% at 2 years, respectively, p < 0.001). Significant independent predictors for IRA-ST were LTB (HR 8.73, p < 0.001), stent thrombosis at presentation (HR 6.24, p = 0.001), bifurcation stenting (HR 4.06, p = 0.002), age (HR 0.55, p = 0.003), and rheolytic thrombectomy (HR 0.11, p = 0.03).

CONCLUSIONS:

Large thrombus burden is an independent predictor of MACE and IRA-ST in patients treated with DES for STEMI.

PMID:
17692740
DOI:
10.1016/j.jacc.2007.04.059
[Indexed for MEDLINE]
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