Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis

Ehrin J. Armstrong, Dmitriy N. Feldman, Tracy Y. Wang, Lisa A. Kaltenbach, Khung Keong Yeo, S. Chiu Wong, John Spertus, Richard E. Shaw, Robert M. Minutello, Issam Moussa, Kalon K L Ho, Jason H Rogers, Kendrick A. Shunk

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106 Citations (Scopus)

Abstract

Objectives: The aim of this study was to describe differences in treatment and in-hospital mortality of early, late, and very late stent thrombosis (ST). Background: Early, late, and very late ST may differ in clinical presentation, management, and in-hospital outcomes. Methods: We analyzed definite (angiographically documented) ST cases identified from February 2009 to June 2010 in the CathPCI Registry. We stratified events by timing of presentation: early (≤1 month), late (1 to 12 months), or very late (<12 months) following stent implantation. Multivariable logistic regression modeling was performed to compare in-hospital mortality for each type of ST after adjusting for baseline comorbidities. Results: During the study period, 7,315 ST events were identified in 7,079 of 401,662 patients (1.8%) presenting with acute coronary syndromes. This ST cohort consisted of 1,391 patients with early ST (19.6%), 1,370 with late ST (19.4%), and 4,318 with very late ST (61.0%). Subjects with early ST had a higher prevalence of black race and diabetes, whereas subjects with very late ST had a higher prevalence of white race and a lower prevalence of prior myocardial infarction or diabetes. In-hospital mortality was significantly higher in early ST (7.9%) compared with late (3.8%) and very late ST (3.6%, p < 0.001). This lower mortality for late and very late ST persisted after multivariable adjustment (odds ratio: 0.53 [95% confidence interval (CI): 0.36 to 0.79] and 0.58 [95% CI: 0.43 to 0.79], respectively). Conclusions: Significant differences exist in the presentation and outcomes of early, late, and very late ST. Among patients with acute coronary syndromes who are undergoing percutaneous coronary intervention for angiographically documented ST, early ST is associated with the highest in-hospital mortality.

Original languageEnglish (US)
Pages (from-to)131-140
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume5
Issue number2
DOIs
StatePublished - Feb 2012

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Stents
Thrombosis
Hospital Mortality
Acute Coronary Syndrome
Confidence Intervals
Percutaneous Coronary Intervention
Registries
Comorbidity

Keywords

  • acute coronary syndrome(s)
  • cardiovascular outcomes
  • stent thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Armstrong, E. J., Feldman, D. N., Wang, T. Y., Kaltenbach, L. A., Yeo, K. K., Wong, S. C., ... Shunk, K. A. (2012). Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. JACC: Cardiovascular Interventions, 5(2), 131-140. https://doi.org/10.1016/j.jcin.2011.10.013

Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. / Armstrong, Ehrin J.; Feldman, Dmitriy N.; Wang, Tracy Y.; Kaltenbach, Lisa A.; Yeo, Khung Keong; Wong, S. Chiu; Spertus, John; Shaw, Richard E.; Minutello, Robert M.; Moussa, Issam; Ho, Kalon K L; Rogers, Jason H; Shunk, Kendrick A.

In: JACC: Cardiovascular Interventions, Vol. 5, No. 2, 02.2012, p. 131-140.

Research output: Contribution to journalArticle

Armstrong, EJ, Feldman, DN, Wang, TY, Kaltenbach, LA, Yeo, KK, Wong, SC, Spertus, J, Shaw, RE, Minutello, RM, Moussa, I, Ho, KKL, Rogers, JH & Shunk, KA 2012, 'Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis', JACC: Cardiovascular Interventions, vol. 5, no. 2, pp. 131-140. https://doi.org/10.1016/j.jcin.2011.10.013
Armstrong, Ehrin J. ; Feldman, Dmitriy N. ; Wang, Tracy Y. ; Kaltenbach, Lisa A. ; Yeo, Khung Keong ; Wong, S. Chiu ; Spertus, John ; Shaw, Richard E. ; Minutello, Robert M. ; Moussa, Issam ; Ho, Kalon K L ; Rogers, Jason H ; Shunk, Kendrick A. / Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. In: JACC: Cardiovascular Interventions. 2012 ; Vol. 5, No. 2. pp. 131-140.
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abstract = "Objectives: The aim of this study was to describe differences in treatment and in-hospital mortality of early, late, and very late stent thrombosis (ST). Background: Early, late, and very late ST may differ in clinical presentation, management, and in-hospital outcomes. Methods: We analyzed definite (angiographically documented) ST cases identified from February 2009 to June 2010 in the CathPCI Registry. We stratified events by timing of presentation: early (≤1 month), late (1 to 12 months), or very late (<12 months) following stent implantation. Multivariable logistic regression modeling was performed to compare in-hospital mortality for each type of ST after adjusting for baseline comorbidities. Results: During the study period, 7,315 ST events were identified in 7,079 of 401,662 patients (1.8{\%}) presenting with acute coronary syndromes. This ST cohort consisted of 1,391 patients with early ST (19.6{\%}), 1,370 with late ST (19.4{\%}), and 4,318 with very late ST (61.0{\%}). Subjects with early ST had a higher prevalence of black race and diabetes, whereas subjects with very late ST had a higher prevalence of white race and a lower prevalence of prior myocardial infarction or diabetes. In-hospital mortality was significantly higher in early ST (7.9{\%}) compared with late (3.8{\%}) and very late ST (3.6{\%}, p < 0.001). This lower mortality for late and very late ST persisted after multivariable adjustment (odds ratio: 0.53 [95{\%} confidence interval (CI): 0.36 to 0.79] and 0.58 [95{\%} CI: 0.43 to 0.79], respectively). Conclusions: Significant differences exist in the presentation and outcomes of early, late, and very late ST. Among patients with acute coronary syndromes who are undergoing percutaneous coronary intervention for angiographically documented ST, early ST is associated with the highest in-hospital mortality.",
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T1 - Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis

AU - Armstrong, Ehrin J.

AU - Feldman, Dmitriy N.

AU - Wang, Tracy Y.

AU - Kaltenbach, Lisa A.

AU - Yeo, Khung Keong

AU - Wong, S. Chiu

AU - Spertus, John

AU - Shaw, Richard E.

AU - Minutello, Robert M.

AU - Moussa, Issam

AU - Ho, Kalon K L

AU - Rogers, Jason H

AU - Shunk, Kendrick A.

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N2 - Objectives: The aim of this study was to describe differences in treatment and in-hospital mortality of early, late, and very late stent thrombosis (ST). Background: Early, late, and very late ST may differ in clinical presentation, management, and in-hospital outcomes. Methods: We analyzed definite (angiographically documented) ST cases identified from February 2009 to June 2010 in the CathPCI Registry. We stratified events by timing of presentation: early (≤1 month), late (1 to 12 months), or very late (<12 months) following stent implantation. Multivariable logistic regression modeling was performed to compare in-hospital mortality for each type of ST after adjusting for baseline comorbidities. Results: During the study period, 7,315 ST events were identified in 7,079 of 401,662 patients (1.8%) presenting with acute coronary syndromes. This ST cohort consisted of 1,391 patients with early ST (19.6%), 1,370 with late ST (19.4%), and 4,318 with very late ST (61.0%). Subjects with early ST had a higher prevalence of black race and diabetes, whereas subjects with very late ST had a higher prevalence of white race and a lower prevalence of prior myocardial infarction or diabetes. In-hospital mortality was significantly higher in early ST (7.9%) compared with late (3.8%) and very late ST (3.6%, p < 0.001). This lower mortality for late and very late ST persisted after multivariable adjustment (odds ratio: 0.53 [95% confidence interval (CI): 0.36 to 0.79] and 0.58 [95% CI: 0.43 to 0.79], respectively). Conclusions: Significant differences exist in the presentation and outcomes of early, late, and very late ST. Among patients with acute coronary syndromes who are undergoing percutaneous coronary intervention for angiographically documented ST, early ST is associated with the highest in-hospital mortality.

AB - Objectives: The aim of this study was to describe differences in treatment and in-hospital mortality of early, late, and very late stent thrombosis (ST). Background: Early, late, and very late ST may differ in clinical presentation, management, and in-hospital outcomes. Methods: We analyzed definite (angiographically documented) ST cases identified from February 2009 to June 2010 in the CathPCI Registry. We stratified events by timing of presentation: early (≤1 month), late (1 to 12 months), or very late (<12 months) following stent implantation. Multivariable logistic regression modeling was performed to compare in-hospital mortality for each type of ST after adjusting for baseline comorbidities. Results: During the study period, 7,315 ST events were identified in 7,079 of 401,662 patients (1.8%) presenting with acute coronary syndromes. This ST cohort consisted of 1,391 patients with early ST (19.6%), 1,370 with late ST (19.4%), and 4,318 with very late ST (61.0%). Subjects with early ST had a higher prevalence of black race and diabetes, whereas subjects with very late ST had a higher prevalence of white race and a lower prevalence of prior myocardial infarction or diabetes. In-hospital mortality was significantly higher in early ST (7.9%) compared with late (3.8%) and very late ST (3.6%, p < 0.001). This lower mortality for late and very late ST persisted after multivariable adjustment (odds ratio: 0.53 [95% confidence interval (CI): 0.36 to 0.79] and 0.58 [95% CI: 0.43 to 0.79], respectively). Conclusions: Significant differences exist in the presentation and outcomes of early, late, and very late ST. Among patients with acute coronary syndromes who are undergoing percutaneous coronary intervention for angiographically documented ST, early ST is associated with the highest in-hospital mortality.

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