Predictors and outcomes of recurrent stent thrombosis

Results from a multicenter registry

Ehrin J. Armstrong, Shiv Sab, Gagan Singh, Wayland Lim, Khung Keong Yeo, Stephen W. Waldo, Mitul Patel, Ryan Reeves, John S. Macgregor, Reginald Low, Kendrick A. Shunk, Ehtisham Mahmud, Jason H Rogers

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objectives The aim of this study was to determine the incidence, predictors, and outcomes of recurrent stent thrombosis (rST).

Background Patients who had an initial stent thrombosis (ST) develop may be at high risk of rST.

Methods We analyzed a multicenter California registry of angiographic definite ST at 5 academic hospitals from 2005 to 2013. A detailed review of the angiogram and procedure was performed of patients with and without rST.

Results Among 221 patients with a median follow-up of 3.3 years, definite or probable rST developed in 29, including 19 with angiographic definite rST. The cumulative hazard ratio (HR) of definite or probable rST was 16% at 1 year and 24% at 5 years, whereas the cumulative HR of angiographic definite rST was 11% at 1 year and 20% at 5 years. Despite similar angiographic results, patients who had rST develop had significantly greater peak creatine kinase at the time of initial ST (mean, 2,655 mg/dl vs. 1,654 mg/dl; p = 0.05) than those without rST. The 3-year rate of major adverse cardiovascular events was 50% for patients with rST compared with 22% for patients with a single ST (p = 0.01). After multivariable adjustment, independent predictors of definite/probable rST were age (HR: 1.4; 95 confidence interval [CI]: 1.1 to 1.8 per 10 years), bifurcation ST (HR: 4.4; 95% CI: 1.8 to 10.9), and proximal vessel diameter (HR: 1.8; 95% CI: 1.1 to 3.2 per millimeter).

Conclusions rST represents an important cause of long-term morbidity and mortality after an initial ST. Bifurcation ST and a larger proximal reference vessel diameter are independently associated with an increased risk of rST.

Original languageEnglish (US)
Pages (from-to)1105-1113
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume7
Issue number10
DOIs
StatePublished - Oct 1 2014

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Stents
Registries
Thrombosis
Confidence Intervals
Creatine Kinase

Keywords

  • angiography
  • recurrent stent thrombosis
  • stent thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictors and outcomes of recurrent stent thrombosis : Results from a multicenter registry. / Armstrong, Ehrin J.; Sab, Shiv; Singh, Gagan; Lim, Wayland; Yeo, Khung Keong; Waldo, Stephen W.; Patel, Mitul; Reeves, Ryan; Macgregor, John S.; Low, Reginald; Shunk, Kendrick A.; Mahmud, Ehtisham; Rogers, Jason H.

In: JACC: Cardiovascular Interventions, Vol. 7, No. 10, 01.10.2014, p. 1105-1113.

Research output: Contribution to journalArticle

Armstrong, EJ, Sab, S, Singh, G, Lim, W, Yeo, KK, Waldo, SW, Patel, M, Reeves, R, Macgregor, JS, Low, R, Shunk, KA, Mahmud, E & Rogers, JH 2014, 'Predictors and outcomes of recurrent stent thrombosis: Results from a multicenter registry', JACC: Cardiovascular Interventions, vol. 7, no. 10, pp. 1105-1113. https://doi.org/10.1016/j.jcin.2014.05.017
Armstrong, Ehrin J. ; Sab, Shiv ; Singh, Gagan ; Lim, Wayland ; Yeo, Khung Keong ; Waldo, Stephen W. ; Patel, Mitul ; Reeves, Ryan ; Macgregor, John S. ; Low, Reginald ; Shunk, Kendrick A. ; Mahmud, Ehtisham ; Rogers, Jason H. / Predictors and outcomes of recurrent stent thrombosis : Results from a multicenter registry. In: JACC: Cardiovascular Interventions. 2014 ; Vol. 7, No. 10. pp. 1105-1113.
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abstract = "Objectives The aim of this study was to determine the incidence, predictors, and outcomes of recurrent stent thrombosis (rST).Background Patients who had an initial stent thrombosis (ST) develop may be at high risk of rST.Methods We analyzed a multicenter California registry of angiographic definite ST at 5 academic hospitals from 2005 to 2013. A detailed review of the angiogram and procedure was performed of patients with and without rST.Results Among 221 patients with a median follow-up of 3.3 years, definite or probable rST developed in 29, including 19 with angiographic definite rST. The cumulative hazard ratio (HR) of definite or probable rST was 16{\%} at 1 year and 24{\%} at 5 years, whereas the cumulative HR of angiographic definite rST was 11{\%} at 1 year and 20{\%} at 5 years. Despite similar angiographic results, patients who had rST develop had significantly greater peak creatine kinase at the time of initial ST (mean, 2,655 mg/dl vs. 1,654 mg/dl; p = 0.05) than those without rST. The 3-year rate of major adverse cardiovascular events was 50{\%} for patients with rST compared with 22{\%} for patients with a single ST (p = 0.01). After multivariable adjustment, independent predictors of definite/probable rST were age (HR: 1.4; 95 confidence interval [CI]: 1.1 to 1.8 per 10 years), bifurcation ST (HR: 4.4; 95{\%} CI: 1.8 to 10.9), and proximal vessel diameter (HR: 1.8; 95{\%} CI: 1.1 to 3.2 per millimeter).Conclusions rST represents an important cause of long-term morbidity and mortality after an initial ST. Bifurcation ST and a larger proximal reference vessel diameter are independently associated with an increased risk of rST.",
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T2 - Results from a multicenter registry

AU - Armstrong, Ehrin J.

AU - Sab, Shiv

AU - Singh, Gagan

AU - Lim, Wayland

AU - Yeo, Khung Keong

AU - Waldo, Stephen W.

AU - Patel, Mitul

AU - Reeves, Ryan

AU - Macgregor, John S.

AU - Low, Reginald

AU - Shunk, Kendrick A.

AU - Mahmud, Ehtisham

AU - Rogers, Jason H

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N2 - Objectives The aim of this study was to determine the incidence, predictors, and outcomes of recurrent stent thrombosis (rST).Background Patients who had an initial stent thrombosis (ST) develop may be at high risk of rST.Methods We analyzed a multicenter California registry of angiographic definite ST at 5 academic hospitals from 2005 to 2013. A detailed review of the angiogram and procedure was performed of patients with and without rST.Results Among 221 patients with a median follow-up of 3.3 years, definite or probable rST developed in 29, including 19 with angiographic definite rST. The cumulative hazard ratio (HR) of definite or probable rST was 16% at 1 year and 24% at 5 years, whereas the cumulative HR of angiographic definite rST was 11% at 1 year and 20% at 5 years. Despite similar angiographic results, patients who had rST develop had significantly greater peak creatine kinase at the time of initial ST (mean, 2,655 mg/dl vs. 1,654 mg/dl; p = 0.05) than those without rST. The 3-year rate of major adverse cardiovascular events was 50% for patients with rST compared with 22% for patients with a single ST (p = 0.01). After multivariable adjustment, independent predictors of definite/probable rST were age (HR: 1.4; 95 confidence interval [CI]: 1.1 to 1.8 per 10 years), bifurcation ST (HR: 4.4; 95% CI: 1.8 to 10.9), and proximal vessel diameter (HR: 1.8; 95% CI: 1.1 to 3.2 per millimeter).Conclusions rST represents an important cause of long-term morbidity and mortality after an initial ST. Bifurcation ST and a larger proximal reference vessel diameter are independently associated with an increased risk of rST.

AB - Objectives The aim of this study was to determine the incidence, predictors, and outcomes of recurrent stent thrombosis (rST).Background Patients who had an initial stent thrombosis (ST) develop may be at high risk of rST.Methods We analyzed a multicenter California registry of angiographic definite ST at 5 academic hospitals from 2005 to 2013. A detailed review of the angiogram and procedure was performed of patients with and without rST.Results Among 221 patients with a median follow-up of 3.3 years, definite or probable rST developed in 29, including 19 with angiographic definite rST. The cumulative hazard ratio (HR) of definite or probable rST was 16% at 1 year and 24% at 5 years, whereas the cumulative HR of angiographic definite rST was 11% at 1 year and 20% at 5 years. Despite similar angiographic results, patients who had rST develop had significantly greater peak creatine kinase at the time of initial ST (mean, 2,655 mg/dl vs. 1,654 mg/dl; p = 0.05) than those without rST. The 3-year rate of major adverse cardiovascular events was 50% for patients with rST compared with 22% for patients with a single ST (p = 0.01). After multivariable adjustment, independent predictors of definite/probable rST were age (HR: 1.4; 95 confidence interval [CI]: 1.1 to 1.8 per 10 years), bifurcation ST (HR: 4.4; 95% CI: 1.8 to 10.9), and proximal vessel diameter (HR: 1.8; 95% CI: 1.1 to 3.2 per millimeter).Conclusions rST represents an important cause of long-term morbidity and mortality after an initial ST. Bifurcation ST and a larger proximal reference vessel diameter are independently associated with an increased risk of rST.

KW - angiography

KW - recurrent stent thrombosis

KW - stent thrombosis

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