Stent thrombosis in the modern era - A pooled analysis of multicenter coronary stent clinical trials

Background-There are limited studies of stent thrombosis in the modem era o f second-generation stents, high-pressure deployment, and current antithrom botic regimens. Methods and Results-Six recently completed coronary stent trials and associ ated nonrandomized registries that enrolled 6186 patients (6219 treated ves sels) treated with greater than or equal to1 coronary stent followed by ant iplatelet therapy with aspirin and ticlopidine were pooled for this analysi s. Within 30 days, clinical stent thrombosis developed in 53 patients (0.9% ). The variables most significantly associated with the probability of sten t thrombosis were persistent dissection NHLBI grade B or higher after stent ing (OR, 3.7; 95% CI, 1.9 to 7.7), total stent length (OR, 1.3; 95% CI, 1.2 to 1.5 per 10 mm), and final minimal lumen diameter within the stent (OR, 0.4; 95% CI, 0.2 to 0.7 per 1 mm). Stent thrombosis was documented by angio graphy in 45 patients (0.7%). Clinical consequences of angiographic stent t hrombosis included 64.4% incidence of death or myocardial infarction at the time of stent thrombosis and 8.9% 6-month mortality. Conclusions-Stent thrombosis occurred in <1.0% of patients undergoing stent ing of native coronary artery lesions and receiving routine antiplatelet th erapy with aspirin plus ticlopidine. Procedure-related variables of persist ent dissection, total stent length, and final lumen diameter were significa ntly associated with the probability of stent thrombosis. Continued efforts to eliminate this complication are warranted given the serious clinical co nsequences.