Background -Stent thrombosis(ST) is a serious complication of drug-eluting stent(DES) implantation regardless of the timing(acute, subacute, or late). The correlates of ST with DES are not yet completely elucidated. M...Background -Stent thrombosis(ST) is a serious complication of drug-eluting stent(DES) implantation regardless of the timing(acute, subacute, or late). The correlates of ST with DES are not yet completely elucidated. Methods and Results -From a total cohort of 2974 consecutive patients treated with DES since April 2003, we identified 38 patients who presented with angiographic evidence of ST(1.27%). The ST occurred acutely in 5 patients, subacutely(≤30 days) in 25 patients, and late( >30 days) in 8 patients. The clinical, angiographie, and procedural variables of these patients were compared with the remaining 2936 consecutive patients who underwent DES implantation and did not experience ST during a follow-up of 12 months. Logistic regression analysis was conducted to determine the correlates of ST. Compared with patients without ST, patients with ST had a higher frequency of diabetes, acute postprocedural renal failure, and chronic renal failure. There were more bifurcation lesions, type C lesions, and a trend for smaller diameter stents. Discontinuation of clopidogrel was higher in these patients(36.8%versus 10.7%; P< 0.0001). The mean duration to ST from the stent implantation was 8.9±8.5 days in subacute and 152.7±100.4 days in late thrombosis cases. Mortality was significantly higher in patients with ST compared with those without ST at 6 months(31%versus 3%; P< 0.001). Multivariate analysis detected cessation of clopidogrel therapy, renal failure, bifurcation lesions, and in-stent restenosis as significant correlates of ST(P< 0.05). Conclusions -ST continues to be a serious complication of contemporary DES use. Careful management is warranted in patients with renal failure and in those undergoing treatment for in-stent restenosis and bifurcations. Special focus on clopidogrel compliance may minimize the incidence of ST after DES implantation.展开更多
Longer stent length has remained associated with the incidence of major adverse cardiac events(MACEs) in the drug-eluting stent(DES) era; therefore, we aimed to determine clinical outcomes after extensive stent covera...Longer stent length has remained associated with the incidence of major adverse cardiac events(MACEs) in the drug-eluting stent(DES) era; therefore, we aimed to determine clinical outcomes after extensive stent coverage with DES implantations in single coronary lesions. We evaluated the data from 99 consecutive patients treated with extensive DES coverage, defined as ≥50 mm(mean 63.3±13.2, range 50 to 115), and a concurrent series of 466 patients with ≤24-mm DES length(mean 18.4±3.8, range 8 to 24). The periprocedural, 1-, and 6-month outcomes were compared between the 2 groups. The baseline characteristics were mostly comparable between the 2 groups, and procedural and in-hospital outcomes were similar. Although the incidence of death and myocardial infarction at follow-up were comparable, the combined end points of target lesion revascularization plus MACEs at 6 months occurred more often with extensive stent coverage. Multivariate analysis revealed stent length to be the only independent predictor of target lesion revascularization plus MACEs. Patients treated with extensive DES coverage had similar procedural success, major in-hospital complications, and death and myocardial infarction at follow-up, but had more combined adverse events because of an overall higher target lesion revascularization rate.展开更多
文摘Background -Stent thrombosis(ST) is a serious complication of drug-eluting stent(DES) implantation regardless of the timing(acute, subacute, or late). The correlates of ST with DES are not yet completely elucidated. Methods and Results -From a total cohort of 2974 consecutive patients treated with DES since April 2003, we identified 38 patients who presented with angiographic evidence of ST(1.27%). The ST occurred acutely in 5 patients, subacutely(≤30 days) in 25 patients, and late( >30 days) in 8 patients. The clinical, angiographie, and procedural variables of these patients were compared with the remaining 2936 consecutive patients who underwent DES implantation and did not experience ST during a follow-up of 12 months. Logistic regression analysis was conducted to determine the correlates of ST. Compared with patients without ST, patients with ST had a higher frequency of diabetes, acute postprocedural renal failure, and chronic renal failure. There were more bifurcation lesions, type C lesions, and a trend for smaller diameter stents. Discontinuation of clopidogrel was higher in these patients(36.8%versus 10.7%; P< 0.0001). The mean duration to ST from the stent implantation was 8.9±8.5 days in subacute and 152.7±100.4 days in late thrombosis cases. Mortality was significantly higher in patients with ST compared with those without ST at 6 months(31%versus 3%; P< 0.001). Multivariate analysis detected cessation of clopidogrel therapy, renal failure, bifurcation lesions, and in-stent restenosis as significant correlates of ST(P< 0.05). Conclusions -ST continues to be a serious complication of contemporary DES use. Careful management is warranted in patients with renal failure and in those undergoing treatment for in-stent restenosis and bifurcations. Special focus on clopidogrel compliance may minimize the incidence of ST after DES implantation.
文摘Longer stent length has remained associated with the incidence of major adverse cardiac events(MACEs) in the drug-eluting stent(DES) era; therefore, we aimed to determine clinical outcomes after extensive stent coverage with DES implantations in single coronary lesions. We evaluated the data from 99 consecutive patients treated with extensive DES coverage, defined as ≥50 mm(mean 63.3±13.2, range 50 to 115), and a concurrent series of 466 patients with ≤24-mm DES length(mean 18.4±3.8, range 8 to 24). The periprocedural, 1-, and 6-month outcomes were compared between the 2 groups. The baseline characteristics were mostly comparable between the 2 groups, and procedural and in-hospital outcomes were similar. Although the incidence of death and myocardial infarction at follow-up were comparable, the combined end points of target lesion revascularization plus MACEs at 6 months occurred more often with extensive stent coverage. Multivariate analysis revealed stent length to be the only independent predictor of target lesion revascularization plus MACEs. Patients treated with extensive DES coverage had similar procedural success, major in-hospital complications, and death and myocardial infarction at follow-up, but had more combined adverse events because of an overall higher target lesion revascularization rate.
