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 journalArticlepeer-review

18 Scopus citations


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
Issue number1
StatePublished - Jan 2012


  • bifurcation
  • stent thrombosis
  • thrombus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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