Angiographic stent thrombosis at coronary bifurcations: Short- and long-term prognosis

Ehrin J. Armstrong, Khung Keong Yeo, Usman Javed, Ehtisham Mahmud, Mitul Patel, Kendrick A. Shunk, John S. MacGregor, Reginald Low, Jason H Rogers

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

This study sought to describe the presentation, management, and outcomes of patients presenting with angiographic definite stent thrombosis (ST) at coronary bifurcations. The development of drug-eluting stents has made it increasingly feasible to treat bifurcation lesions percutaneously. However, ST at coronary bifurcations may be associated with greater mortality than ST elsewhere. We analyzed a multicenter California registry comprising all cases of angiographic definite ST at 5 academic hospitals from 2005 to 2010. Stenting was defined as occurring at a bifurcation if the main vessel stent crossed a side branch <2.0 mm in diameter (provisional single-stent approach), or if there was a prior 2-stent bifurcation approach. Among 173 cases of angiographic definite ST, we identified 20 cases of ST at coronary bifurcations. Nine of 20 bifurcation ST (45%) occurred with a stent present in both the parent and branch vessel. Eight cases had thrombus present in both the parent and side branch vessels. In-hospital mortality was much higher for subjects with bifurcation ST than ST at a nonbifurcation site (20% vs. 2%, p < 0.0001). During a median follow-up of 2.3 years, ST at a coronary bifurcation was associated with increased long-term mortality (hazard ratio [HR]: 3.3, 95% confidence interval [CI]: 1.4 to 7.7, p = 0.007) and a significantly higher risk for major adverse cardiovascular events (HR: 2.2, 95% CI: 1.04 to 4.8, p = 0.04) relative to ST at a nonbifurcation site. ST at coronary bifurcations is associated with a higher in-hospital and long-term mortality than ST at nonbifurcation lesions. (Stent Thrombus in Acute Coronary Syndromes; NCT00931502)

Original languageEnglish (US)
Pages (from-to)57-63
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume5
Issue number1
DOIs
StatePublished - Jan 2012

Keywords

  • bifurcation
  • stent thrombosis
  • thrombus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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