Stent thrombosis definitions
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Issues with interpreting data
Some clinical trials excluded patients who underwent repeat target vessel revascularization. Given that this is more likely to be on a BMS, there might have been room for bias. In some studies definition of late ST may have underestimated the true incidence of ST due to the exclusion of unexplained myocardial infarction (MI)s in the territory of the stented vessels and late deaths, which may have been due to stent thromboses.
In some trials the patient who presented for revascularization of BMS patients were exluded which may have biased the interpretation of the results.
Most commonly used definitions
There have been differing definitions in different studies.
Definition based on timing of stent thrombosis (ST)
- Acute < 24 hrs
- Subacute 24 hrs – 30 days and
- Evidence of ST by way of one or more of
- angiographic vessel occlusion with TIMI 0-1 flow
- new Q-wave MI in an area supplied by the stented vessel,
- unexplained death from a cardiac cause
- Evidence of ST by way of one or more of
Some studies looked at clinical events from soon after procedure to a few days after the procedure. One of the reasons for this method was that a significant proportion of clinical events in this time period was proceudure related.
- Late ST 30 d - 360 days
- > 30 d following stent implantation and new myocardial infarction (MI) with occlusion of the stented artery on angiography.
Some studies had a definition of “ late” after the 6th month.
- Very Late ST > 360 days
- ( > 4 yrs ) At the moment there is only sparse data beyond four years.
Definition based on certainty of ST
In order to standardize and semi-quantify the certainty of ST, the academic research consortium (ARC) recommended the following classification (ref )
- Definite ST
- Angiographic confirmation of thrombus, with or without vessel occlusion, associated with
- clinical or ECG signs of acute ischemia or
- elevation of serum creatinine kinase (CK) to twice the normal value within 48 hours of angiography.
- Angiographic confirmation of thrombus, with or without vessel occlusion, associated with
- Probable ST
- Unexplained death occurring within 30 days after the index procedure or
- if a myocardial infarction, occurring at any time after the index procedure, was documented in an area supplied by the stented vessel in the absence of angiographic confirmation of stent thrombosis or other culprit lesion.
- Possible ST
Unexplained death occurring more than 30 days after the index procedure.
NOTE : Events occurring after repeat target lesion revascularization would be included.
Other definitions
Return to main Coronary stent thrombosis page
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Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
