Correlates and outcomes of late and very late drug-eluting stent thrombosis: results from DESERT (International Drug-Eluting Stent Event Registry of Thrombosis)
The aim of this study was to identify clinical, procedural, and angiographic correlates of late/very late drug-eluting stent (DES) thrombosis as well as to determine the clinical outcomes of these events. Late/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infre...
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| Veröffentlicht in: | JACC. Cardiovascular interventions 2014-10, Vol.7 (10), p.1093-1102 |
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| creator | Waksman, Ron Kirtane, Ajay J Torguson, Rebecca Cohen, David J Ryan, Thomas Räber, Lorenz Applegate, Robert Waxman, Sergio Gordon, Paul Kaneshige, Kimberly Leon, Martin B |
| description | The aim of this study was to identify clinical, procedural, and angiographic correlates of late/very late drug-eluting stent (DES) thrombosis as well as to determine the clinical outcomes of these events.
Late/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infrequency of these events, even in large cohort studies.
In the DESERT (International Drug-Eluting Stent Event Registry of Thrombosis), a retrospective, case-control registry, 492 cases of late/very late definite DES thrombosis from 21 international sites were matched in a 1:1 fashion with controls without stent thrombosis (ST). Controls were matched according to 2 criteria: same enrolling institution and date of initial DES implantation. Baseline and procedural variables were collected, and clinical follow-up was obtained for patients with ST as long as 1 year after the event. Offline quantitative coronary angiography was performed for a subset of 378 case-control pairs.
The majority of ST events occurred after 1 year (75%) and continued to occur for as long as 7.3 years. The clinical presentation of late/very late ST events was mainly myocardial infarction (66.7% ST-segment elevation myocardial infarction and 22.0% non-ST-segment elevation myocardial infarction); in-hospital mortality was 3.8%. A minority of patients (30%) with ST were receiving dual-antiplatelet therapy at the time of the event. Independent clinical correlates of late/very late ST were younger age, African-American race, current smoking, multivessel disease, longer stented length, overlapping stents, and percutaneous coronary intervention of vein graft lesions. Independent angiographic correlates for late/very late ST were lesions within the left anterior descending artery or a bypass graft, thrombus, and a larger residual diameter stenosis after the initial DES implantation. Despite the large sample of ST cases, all identified correlates of late/very late ST had weak associations with subsequent ST (all odds ratios |
| doi_str_mv | 10.1016/j.jcin.2014.04.017 |
| format | Article |
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Late/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infrequency of these events, even in large cohort studies.
In the DESERT (International Drug-Eluting Stent Event Registry of Thrombosis), a retrospective, case-control registry, 492 cases of late/very late definite DES thrombosis from 21 international sites were matched in a 1:1 fashion with controls without stent thrombosis (ST). Controls were matched according to 2 criteria: same enrolling institution and date of initial DES implantation. Baseline and procedural variables were collected, and clinical follow-up was obtained for patients with ST as long as 1 year after the event. Offline quantitative coronary angiography was performed for a subset of 378 case-control pairs.
The majority of ST events occurred after 1 year (75%) and continued to occur for as long as 7.3 years. The clinical presentation of late/very late ST events was mainly myocardial infarction (66.7% ST-segment elevation myocardial infarction and 22.0% non-ST-segment elevation myocardial infarction); in-hospital mortality was 3.8%. A minority of patients (30%) with ST were receiving dual-antiplatelet therapy at the time of the event. Independent clinical correlates of late/very late ST were younger age, African-American race, current smoking, multivessel disease, longer stented length, overlapping stents, and percutaneous coronary intervention of vein graft lesions. Independent angiographic correlates for late/very late ST were lesions within the left anterior descending artery or a bypass graft, thrombus, and a larger residual diameter stenosis after the initial DES implantation. Despite the large sample of ST cases, all identified correlates of late/very late ST had weak associations with subsequent ST (all odds ratios <2.5).
Despite a large sample of ST cases and use of limited matching to maximize the identification of predictive factors associated with late/very late ST, the variables associated with the development of late/very late ST were only weakly predictive of subsequent events. Additionally, a relatively low observed mortality rate of ST in this series may reflect a different pathophysiology of these late/very late events compared with acute/subacute ST. (Drug Eluting Stent Registry of Thrombosis [DESERT]; NCT00812552).</description><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2014.04.017</identifier><identifier>PMID: 25240540</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Coronary Angiography ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - mortality ; Coronary Artery Disease - therapy ; Coronary Thrombosis - diagnosis ; Coronary Thrombosis - etiology ; Coronary Thrombosis - mortality ; Coronary Thrombosis - physiopathology ; Drug Therapy, Combination ; Drug-Eluting Stents ; Female ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction - etiology ; Myocardial Infarction - mortality ; Odds Ratio ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - instrumentation ; Percutaneous Coronary Intervention - mortality ; Platelet Aggregation Inhibitors - therapeutic use ; Prosthesis Design ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome</subject><ispartof>JACC. Cardiovascular interventions, 2014-10, Vol.7 (10), p.1093-1102</ispartof><rights>Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25240540$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Waksman, Ron</creatorcontrib><creatorcontrib>Kirtane, Ajay J</creatorcontrib><creatorcontrib>Torguson, Rebecca</creatorcontrib><creatorcontrib>Cohen, David J</creatorcontrib><creatorcontrib>Ryan, Thomas</creatorcontrib><creatorcontrib>Räber, Lorenz</creatorcontrib><creatorcontrib>Applegate, Robert</creatorcontrib><creatorcontrib>Waxman, Sergio</creatorcontrib><creatorcontrib>Gordon, Paul</creatorcontrib><creatorcontrib>Kaneshige, Kimberly</creatorcontrib><creatorcontrib>Leon, Martin B</creatorcontrib><creatorcontrib>DESERT Investigators</creatorcontrib><title>Correlates and outcomes of late and very late drug-eluting stent thrombosis: results from DESERT (International Drug-Eluting Stent Event Registry of Thrombosis)</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>The aim of this study was to identify clinical, procedural, and angiographic correlates of late/very late drug-eluting stent (DES) thrombosis as well as to determine the clinical outcomes of these events.
Late/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infrequency of these events, even in large cohort studies.
In the DESERT (International Drug-Eluting Stent Event Registry of Thrombosis), a retrospective, case-control registry, 492 cases of late/very late definite DES thrombosis from 21 international sites were matched in a 1:1 fashion with controls without stent thrombosis (ST). Controls were matched according to 2 criteria: same enrolling institution and date of initial DES implantation. Baseline and procedural variables were collected, and clinical follow-up was obtained for patients with ST as long as 1 year after the event. Offline quantitative coronary angiography was performed for a subset of 378 case-control pairs.
The majority of ST events occurred after 1 year (75%) and continued to occur for as long as 7.3 years. The clinical presentation of late/very late ST events was mainly myocardial infarction (66.7% ST-segment elevation myocardial infarction and 22.0% non-ST-segment elevation myocardial infarction); in-hospital mortality was 3.8%. A minority of patients (30%) with ST were receiving dual-antiplatelet therapy at the time of the event. Independent clinical correlates of late/very late ST were younger age, African-American race, current smoking, multivessel disease, longer stented length, overlapping stents, and percutaneous coronary intervention of vein graft lesions. Independent angiographic correlates for late/very late ST were lesions within the left anterior descending artery or a bypass graft, thrombus, and a larger residual diameter stenosis after the initial DES implantation. Despite the large sample of ST cases, all identified correlates of late/very late ST had weak associations with subsequent ST (all odds ratios <2.5).
Despite a large sample of ST cases and use of limited matching to maximize the identification of predictive factors associated with late/very late ST, the variables associated with the development of late/very late ST were only weakly predictive of subsequent events. Additionally, a relatively low observed mortality rate of ST in this series may reflect a different pathophysiology of these late/very late events compared with acute/subacute ST. (Drug Eluting Stent Registry of Thrombosis [DESERT]; NCT00812552).</description><subject>Aged</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary Thrombosis - diagnosis</subject><subject>Coronary Thrombosis - etiology</subject><subject>Coronary Thrombosis - mortality</subject><subject>Coronary Thrombosis - physiopathology</subject><subject>Drug Therapy, Combination</subject><subject>Drug-Eluting Stents</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Myocardial Infarction - etiology</subject><subject>Myocardial Infarction - mortality</subject><subject>Odds Ratio</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - instrumentation</subject><subject>Percutaneous Coronary Intervention - mortality</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Prosthesis Design</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kN1Kw0AQhRdB_H8BL2Qv60XizCbdTb2TGn-gIGi9Dpt0tqYk2bq7Kfg2PqqprcIwwzkcvgPD2CVCjIDyZhWvqrqLBWAawzCoDtgJZkpGSsL4mJ16vwKQMFHiiB2LsUhhnMIJ-55a56jRgTzX3YLbPlS2HYQ1fOv-mhtyXzu1cP0yoqYPdbfkPlAXePhwti2tr_0td-T7JnhuBovf52_565yPnrtArtOhtp1u-P2WkO8Jb7-EfLPdr7SsfRiKhub5P_P6nB0a3Xi62N8z9v6Qz6dP0ezl8Xl6N4vWAjFEiZGIpVRUksA0MUZNSsJMVGi01ioBaRBMBYkCKSaJhixL05SGJ2gAECo5Y6Mdd-3sZ08-FG3tK2oa3ZHtfYESZZoBjrMherWP9mVLi2Lt6la7r-Lvq8kPiTl6hg</recordid><startdate>201410</startdate><enddate>201410</enddate><creator>Waksman, Ron</creator><creator>Kirtane, Ajay J</creator><creator>Torguson, Rebecca</creator><creator>Cohen, David J</creator><creator>Ryan, Thomas</creator><creator>Räber, Lorenz</creator><creator>Applegate, Robert</creator><creator>Waxman, Sergio</creator><creator>Gordon, Paul</creator><creator>Kaneshige, Kimberly</creator><creator>Leon, Martin B</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201410</creationdate><title>Correlates and outcomes of late and very late drug-eluting stent thrombosis: results from DESERT (International Drug-Eluting Stent Event Registry of Thrombosis)</title><author>Waksman, Ron ; Kirtane, Ajay J ; Torguson, Rebecca ; Cohen, David J ; Ryan, Thomas ; Räber, Lorenz ; Applegate, Robert ; Waxman, Sergio ; Gordon, Paul ; Kaneshige, Kimberly ; Leon, Martin B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p211t-3f611b67ebe2143ff79be182c1faaa7306f10fc03706293a088444e054a000273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary Thrombosis - diagnosis</topic><topic>Coronary Thrombosis - etiology</topic><topic>Coronary Thrombosis - mortality</topic><topic>Coronary Thrombosis - physiopathology</topic><topic>Drug Therapy, Combination</topic><topic>Drug-Eluting Stents</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Myocardial Infarction - etiology</topic><topic>Myocardial Infarction - mortality</topic><topic>Odds Ratio</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Percutaneous Coronary Intervention - instrumentation</topic><topic>Percutaneous Coronary Intervention - mortality</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Prosthesis Design</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Waksman, Ron</creatorcontrib><creatorcontrib>Kirtane, Ajay J</creatorcontrib><creatorcontrib>Torguson, Rebecca</creatorcontrib><creatorcontrib>Cohen, David J</creatorcontrib><creatorcontrib>Ryan, Thomas</creatorcontrib><creatorcontrib>Räber, Lorenz</creatorcontrib><creatorcontrib>Applegate, Robert</creatorcontrib><creatorcontrib>Waxman, Sergio</creatorcontrib><creatorcontrib>Gordon, Paul</creatorcontrib><creatorcontrib>Kaneshige, Kimberly</creatorcontrib><creatorcontrib>Leon, Martin B</creatorcontrib><creatorcontrib>DESERT Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Waksman, Ron</au><au>Kirtane, Ajay J</au><au>Torguson, Rebecca</au><au>Cohen, David J</au><au>Ryan, Thomas</au><au>Räber, Lorenz</au><au>Applegate, Robert</au><au>Waxman, Sergio</au><au>Gordon, Paul</au><au>Kaneshige, Kimberly</au><au>Leon, Martin B</au><aucorp>DESERT Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Correlates and outcomes of late and very late drug-eluting stent thrombosis: results from DESERT (International Drug-Eluting Stent Event Registry of Thrombosis)</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2014-10</date><risdate>2014</risdate><volume>7</volume><issue>10</issue><spage>1093</spage><epage>1102</epage><pages>1093-1102</pages><eissn>1876-7605</eissn><abstract>The aim of this study was to identify clinical, procedural, and angiographic correlates of late/very late drug-eluting stent (DES) thrombosis as well as to determine the clinical outcomes of these events.
Late/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infrequency of these events, even in large cohort studies.
In the DESERT (International Drug-Eluting Stent Event Registry of Thrombosis), a retrospective, case-control registry, 492 cases of late/very late definite DES thrombosis from 21 international sites were matched in a 1:1 fashion with controls without stent thrombosis (ST). Controls were matched according to 2 criteria: same enrolling institution and date of initial DES implantation. Baseline and procedural variables were collected, and clinical follow-up was obtained for patients with ST as long as 1 year after the event. Offline quantitative coronary angiography was performed for a subset of 378 case-control pairs.
The majority of ST events occurred after 1 year (75%) and continued to occur for as long as 7.3 years. The clinical presentation of late/very late ST events was mainly myocardial infarction (66.7% ST-segment elevation myocardial infarction and 22.0% non-ST-segment elevation myocardial infarction); in-hospital mortality was 3.8%. A minority of patients (30%) with ST were receiving dual-antiplatelet therapy at the time of the event. Independent clinical correlates of late/very late ST were younger age, African-American race, current smoking, multivessel disease, longer stented length, overlapping stents, and percutaneous coronary intervention of vein graft lesions. Independent angiographic correlates for late/very late ST were lesions within the left anterior descending artery or a bypass graft, thrombus, and a larger residual diameter stenosis after the initial DES implantation. Despite the large sample of ST cases, all identified correlates of late/very late ST had weak associations with subsequent ST (all odds ratios <2.5).
Despite a large sample of ST cases and use of limited matching to maximize the identification of predictive factors associated with late/very late ST, the variables associated with the development of late/very late ST were only weakly predictive of subsequent events. Additionally, a relatively low observed mortality rate of ST in this series may reflect a different pathophysiology of these late/very late events compared with acute/subacute ST. (Drug Eluting Stent Registry of Thrombosis [DESERT]; NCT00812552).</abstract><cop>United States</cop><pmid>25240540</pmid><doi>10.1016/j.jcin.2014.04.017</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | EISSN: 1876-7605 |
| ispartof | JACC. Cardiovascular interventions, 2014-10, Vol.7 (10), p.1093-1102 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present); Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Coronary Angiography Coronary Artery Disease - diagnosis Coronary Artery Disease - mortality Coronary Artery Disease - therapy Coronary Thrombosis - diagnosis Coronary Thrombosis - etiology Coronary Thrombosis - mortality Coronary Thrombosis - physiopathology Drug Therapy, Combination Drug-Eluting Stents Female Hospital Mortality Humans Logistic Models Male Middle Aged Multivariate Analysis Myocardial Infarction - etiology Myocardial Infarction - mortality Odds Ratio Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - instrumentation Percutaneous Coronary Intervention - mortality Platelet Aggregation Inhibitors - therapeutic use Prosthesis Design Registries Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome |
| title | Correlates and outcomes of late and very late drug-eluting stent thrombosis: results from DESERT (International Drug-Eluting Stent Event Registry of Thrombosis) |
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