Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period
Aims To assess the incidence, timing, and relation of drug-eluting stent (DES) thrombosis to discontinuation of clopidogrel therapy. Methods and results This prospective observational cohort study included 6816 consecutive patients that underwent successful DES implantation. Primary endpoint was def...
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| Veröffentlicht in: | European heart journal 2009-11, Vol.30 (22), p.2714-2721 |
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| creator | Schulz, Stefanie Schuster, Tibor Mehilli, Julinda Byrne, Robert A. Ellert, Julia Massberg, Steffen Goedel, Julia Bruskina, Olga Ulm, Kurt Schömig, Albert Kastrati, Adnan |
| description | Aims To assess the incidence, timing, and relation of drug-eluting stent (DES) thrombosis to discontinuation of clopidogrel therapy. Methods and results This prospective observational cohort study included 6816 consecutive patients that underwent successful DES implantation. Primary endpoint was definite stent thrombosis (ST). During 4 years of follow-up, definite ST was observed in 73 patients, corresponding to a cumulative incidence of 1.2%. Cumulative incidence of ST at 30 days was 0.5 and 0.8% at 1 year, respectively. Discontinuation of clopidogrel therapy was significantly associated with ST only in the first 6 months after the procedure (P < 0.001). During that period, the median time interval from clopidogrel discontinuation to ST was 9 days [interquartile range (IQR) 5.5–22.5] while thereafter it was 104.3 days (IQR 7.4–294.8). Conclusion The 4 year incidence of ST after DES implantation is low. A relevant number of ST occur early after discontinuation of clopidogrel therapy. The dependence of ST on discontinuation of clopidogrel therapy seems to be mostly confined to the first 6 months after DES implantation. However, specifically designed randomized studies are required to establish the optimal length of clopidogrel therapy after DES implantation. |
| doi_str_mv | 10.1093/eurheartj/ehp275 |
| format | Article |
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Methods and results This prospective observational cohort study included 6816 consecutive patients that underwent successful DES implantation. Primary endpoint was definite stent thrombosis (ST). During 4 years of follow-up, definite ST was observed in 73 patients, corresponding to a cumulative incidence of 1.2%. Cumulative incidence of ST at 30 days was 0.5 and 0.8% at 1 year, respectively. Discontinuation of clopidogrel therapy was significantly associated with ST only in the first 6 months after the procedure (P < 0.001). During that period, the median time interval from clopidogrel discontinuation to ST was 9 days [interquartile range (IQR) 5.5–22.5] while thereafter it was 104.3 days (IQR 7.4–294.8). Conclusion The 4 year incidence of ST after DES implantation is low. A relevant number of ST occur early after discontinuation of clopidogrel therapy. The dependence of ST on discontinuation of clopidogrel therapy seems to be mostly confined to the first 6 months after DES implantation. However, specifically designed randomized studies are required to establish the optimal length of clopidogrel therapy after DES implantation.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehp275</identifier><identifier>PMID: 19596658</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Aged ; Biological and medical sciences ; Blood Vessel Prosthesis ; Cardiology. Vascular system ; Clopidogrel ; Coronary Angiography ; Drug-eluting stent ; Drug-Eluting Stents ; Female ; Graft Occlusion, Vascular - diagnostic imaging ; Graft Occlusion, Vascular - etiology ; Humans ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - etiology ; Platelet Aggregation Inhibitors - administration & dosage ; Prospective Studies ; Stent thrombosis ; Ticlopidine - administration & dosage ; Ticlopidine - analogs & derivatives</subject><ispartof>European heart journal, 2009-11, Vol.30 (22), p.2714-2721</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org 2009</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c510t-3d75bb13de41bff44eba60f6ff3fc9ffcdab3f50a4d842ac8c1015fba6702ef13</citedby><cites>FETCH-LOGICAL-c510t-3d75bb13de41bff44eba60f6ff3fc9ffcdab3f50a4d842ac8c1015fba6702ef13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22119444$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19596658$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schulz, Stefanie</creatorcontrib><creatorcontrib>Schuster, Tibor</creatorcontrib><creatorcontrib>Mehilli, Julinda</creatorcontrib><creatorcontrib>Byrne, Robert A.</creatorcontrib><creatorcontrib>Ellert, Julia</creatorcontrib><creatorcontrib>Massberg, Steffen</creatorcontrib><creatorcontrib>Goedel, Julia</creatorcontrib><creatorcontrib>Bruskina, Olga</creatorcontrib><creatorcontrib>Ulm, Kurt</creatorcontrib><creatorcontrib>Schömig, Albert</creatorcontrib><creatorcontrib>Kastrati, Adnan</creatorcontrib><title>Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims To assess the incidence, timing, and relation of drug-eluting stent (DES) thrombosis to discontinuation of clopidogrel therapy. Methods and results This prospective observational cohort study included 6816 consecutive patients that underwent successful DES implantation. Primary endpoint was definite stent thrombosis (ST). During 4 years of follow-up, definite ST was observed in 73 patients, corresponding to a cumulative incidence of 1.2%. Cumulative incidence of ST at 30 days was 0.5 and 0.8% at 1 year, respectively. Discontinuation of clopidogrel therapy was significantly associated with ST only in the first 6 months after the procedure (P < 0.001). During that period, the median time interval from clopidogrel discontinuation to ST was 9 days [interquartile range (IQR) 5.5–22.5] while thereafter it was 104.3 days (IQR 7.4–294.8). Conclusion The 4 year incidence of ST after DES implantation is low. A relevant number of ST occur early after discontinuation of clopidogrel therapy. The dependence of ST on discontinuation of clopidogrel therapy seems to be mostly confined to the first 6 months after DES implantation. However, specifically designed randomized studies are required to establish the optimal length of clopidogrel therapy after DES implantation.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood Vessel Prosthesis</subject><subject>Cardiology. Vascular system</subject><subject>Clopidogrel</subject><subject>Coronary Angiography</subject><subject>Drug-eluting stent</subject><subject>Drug-Eluting Stents</subject><subject>Female</subject><subject>Graft Occlusion, Vascular - diagnostic imaging</subject><subject>Graft Occlusion, Vascular - etiology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - etiology</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Prospective Studies</subject><subject>Stent thrombosis</subject><subject>Ticlopidine - administration & dosage</subject><subject>Ticlopidine - analogs & derivatives</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU9v1DAQxS1ERZfCnRPyBXGgoXbsOAk3WPUPqBKHglRxsRx7vOuSxMF2UPeL8Hlxm9Vy5WRr9Jv3ZuYh9IqS95S07AzmsAUV0t0ZbKeyrp6gFa3KsmgFr56iFaFtVQjR3B6j5zHeEUIaQcUzdJzrrRBVs0J_bhKMCadt8EPno4tY2QQBmzBvCujn5MYNjo-MG6ZejUkl58cP2I3aGRg1nOLkhkydYjUaHKB_BHDy2Lio_ZgV5qXkLda9n5zxm4xlTwhq2mH_O_spzItdXgVPEJw3L9CRVX2El_v3BH2_OP-2viquv15-Xn-8LnRFSSqYqauuo8wAp521nEOnBLHCWmZ1a602qmO2IoqbhpdKN5oSWtkM1aQES9kJervoTsH_miEmOeShoc-Lgp-jrBmrW940PJNkIXXwMQawcgpuUGEnKZEPYchDGHIJI7e83ovP3QDmX8P--hl4swdU1Kq3QeWjxgNXlpS2nD94v1s4P0__Y1sstMu53R94FX5KUbO6kle3P_JvfcM_fWnkBfsL9OO5Yw</recordid><startdate>20091101</startdate><enddate>20091101</enddate><creator>Schulz, Stefanie</creator><creator>Schuster, Tibor</creator><creator>Mehilli, Julinda</creator><creator>Byrne, Robert A.</creator><creator>Ellert, Julia</creator><creator>Massberg, Steffen</creator><creator>Goedel, Julia</creator><creator>Bruskina, Olga</creator><creator>Ulm, Kurt</creator><creator>Schömig, Albert</creator><creator>Kastrati, Adnan</creator><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20091101</creationdate><title>Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period</title><author>Schulz, Stefanie ; Schuster, Tibor ; Mehilli, Julinda ; Byrne, Robert A. ; Ellert, Julia ; Massberg, Steffen ; Goedel, Julia ; Bruskina, Olga ; Ulm, Kurt ; Schömig, Albert ; Kastrati, Adnan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c510t-3d75bb13de41bff44eba60f6ff3fc9ffcdab3f50a4d842ac8c1015fba6702ef13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood Vessel Prosthesis</topic><topic>Cardiology. Vascular system</topic><topic>Clopidogrel</topic><topic>Coronary Angiography</topic><topic>Drug-eluting stent</topic><topic>Drug-Eluting Stents</topic><topic>Female</topic><topic>Graft Occlusion, Vascular - diagnostic imaging</topic><topic>Graft Occlusion, Vascular - etiology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - etiology</topic><topic>Platelet Aggregation Inhibitors - administration & dosage</topic><topic>Prospective Studies</topic><topic>Stent thrombosis</topic><topic>Ticlopidine - administration & dosage</topic><topic>Ticlopidine - analogs & derivatives</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schulz, Stefanie</creatorcontrib><creatorcontrib>Schuster, Tibor</creatorcontrib><creatorcontrib>Mehilli, Julinda</creatorcontrib><creatorcontrib>Byrne, Robert A.</creatorcontrib><creatorcontrib>Ellert, Julia</creatorcontrib><creatorcontrib>Massberg, Steffen</creatorcontrib><creatorcontrib>Goedel, Julia</creatorcontrib><creatorcontrib>Bruskina, Olga</creatorcontrib><creatorcontrib>Ulm, Kurt</creatorcontrib><creatorcontrib>Schömig, Albert</creatorcontrib><creatorcontrib>Kastrati, Adnan</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schulz, Stefanie</au><au>Schuster, Tibor</au><au>Mehilli, Julinda</au><au>Byrne, Robert A.</au><au>Ellert, Julia</au><au>Massberg, Steffen</au><au>Goedel, Julia</au><au>Bruskina, Olga</au><au>Ulm, Kurt</au><au>Schömig, Albert</au><au>Kastrati, Adnan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2009-11-01</date><risdate>2009</risdate><volume>30</volume><issue>22</issue><spage>2714</spage><epage>2721</epage><pages>2714-2721</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims To assess the incidence, timing, and relation of drug-eluting stent (DES) thrombosis to discontinuation of clopidogrel therapy. Methods and results This prospective observational cohort study included 6816 consecutive patients that underwent successful DES implantation. Primary endpoint was definite stent thrombosis (ST). During 4 years of follow-up, definite ST was observed in 73 patients, corresponding to a cumulative incidence of 1.2%. Cumulative incidence of ST at 30 days was 0.5 and 0.8% at 1 year, respectively. Discontinuation of clopidogrel therapy was significantly associated with ST only in the first 6 months after the procedure (P < 0.001). During that period, the median time interval from clopidogrel discontinuation to ST was 9 days [interquartile range (IQR) 5.5–22.5] while thereafter it was 104.3 days (IQR 7.4–294.8). Conclusion The 4 year incidence of ST after DES implantation is low. A relevant number of ST occur early after discontinuation of clopidogrel therapy. The dependence of ST on discontinuation of clopidogrel therapy seems to be mostly confined to the first 6 months after DES implantation. However, specifically designed randomized studies are required to establish the optimal length of clopidogrel therapy after DES implantation.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>19596658</pmid><doi>10.1093/eurheartj/ehp275</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Biological and medical sciences Blood Vessel Prosthesis Cardiology. Vascular system Clopidogrel Coronary Angiography Drug-eluting stent Drug-Eluting Stents Female Graft Occlusion, Vascular - diagnostic imaging Graft Occlusion, Vascular - etiology Humans Male Medical sciences Middle Aged Myocardial Infarction - etiology Platelet Aggregation Inhibitors - administration & dosage Prospective Studies Stent thrombosis Ticlopidine - administration & dosage Ticlopidine - analogs & derivatives |
| title | Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period |
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