Predictors of coronary stent thrombosis: Difference between revisions
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A number of clinical, angiographic, and procedural factors predispose to the occurrence of stent thrombosis. Predictors of stent thrombosis can be classified into anatomic variables, procedure related variables and clinical variables. A new entity which has been recently recognised and is being increasingly studied in relation to stent thrombosis is hyporesponsiveness to antiplatelet agents. | A number of clinical, angiographic, and procedural factors predispose to the occurrence of stent thrombosis. Predictors of stent thrombosis can be classified into anatomic variables, procedure related variables and clinical variables. A new entity which has been recently recognised and is being increasingly studied in relation to stent thrombosis is hyporesponsiveness to antiplatelet agents. | ||
'''Procedure related variables:''' | |||
Procedure related variables include stent underexpansion, margin dissections, incomplete wall apposition, residual inflow and outflow disease, overlapping stent, polymer materials. | Procedure related variables include stent underexpansion, margin dissections, incomplete wall apposition, residual inflow and outflow disease, overlapping stent, polymer materials. | ||
'''Anatomic variables:''' | |||
Lesion-specific factors that increase the likelihood of stent thrombosis include a residual dissection at the margin of the stent, impaired flow into or out of the stent, small stent diameters (<3 mm), long stent lengths, and treatment of an acute myocardial infarction. | Lesion-specific factors that increase the likelihood of stent thrombosis include a residual dissection at the margin of the stent, impaired flow into or out of the stent, small stent diameters (<3 mm), long stent lengths, and treatment of an acute myocardial infarction. | ||
'''Clinical variables:''' | |||
Clinical variables include acute myocardial infarction, clopidogrel noncompliance and discontinuation, hyporesponsiveness to antiplatelet agents, diabetes mellitus, renal failure, congestive heart failure, prior radiation brachytherapy. | Clinical variables include acute myocardial infarction, clopidogrel noncompliance and discontinuation, hyporesponsiveness to antiplatelet agents, diabetes mellitus, renal failure, congestive heart failure, prior radiation brachytherapy. | ||
In addition to these, stent implantation for off-label indication(such as restenotic lesions, bypass graft lesions, left main coronary artery disease, as well as ostial, bifurcated, and totally occluded lesions) of both DES and BMS has been associated with higher rates of ischemic complications, including stent thrombosis, as compared with standard indications<ref name="pmid17488964">{{cite journal |author=Beohar N, Davidson CJ, Kip KE, ''et al.'' |title=Outcomes and complications associated with off-label and untested use of drug-eluting stents |journal=JAMA |volume=297 |issue=18 |pages=1992–2000 |year=2007 |month=May |pmid=17488964 |doi=10.1001/jama.297.18.1992 |url=}}</ref><ref name="pmid17488965">{{cite journal |author=Win HK, Caldera AE, Maresh K, ''et al.'' |title=Clinical outcomes and stent thrombosis following off-label use of drug-eluting stents |journal=JAMA |volume=297 |issue=18 |pages=2001–9 |year=2007 |month=May |pmid=17488965 |doi=10.1001/jama.297.18.2001 |url=}}</ref>. | In addition to these, stent implantation for off-label indication(such as restenotic lesions, bypass graft lesions, left main coronary artery disease, as well as ostial, bifurcated, and totally occluded lesions) of both DES and BMS has been associated with higher rates of ischemic complications, including stent thrombosis, as compared with standard indications<ref name="pmid17488964">{{cite journal |author=Beohar N, Davidson CJ, Kip KE, ''et al.'' |title=Outcomes and complications associated with off-label and untested use of drug-eluting stents |journal=JAMA |volume=297 |issue=18 |pages=1992–2000 |year=2007 |month=May |pmid=17488964 |doi=10.1001/jama.297.18.1992 |url=}}</ref><ref name="pmid17488965">{{cite journal |author=Win HK, Caldera AE, Maresh K, ''et al.'' |title=Clinical outcomes and stent thrombosis following off-label use of drug-eluting stents |journal=JAMA |volume=297 |issue=18 |pages=2001–9 |year=2007 |month=May |pmid=17488965 |doi=10.1001/jama.297.18.2001 |url=}}</ref>. | ||
A study by Marroquin et al<ref name="pmid18216354">{{cite journal |author=Marroquin OC, Selzer F, Mulukutla SR, ''et al.'' |title=A comparison of bare-metal and drug-eluting stents for off-label indications |journal=N. Engl. J. Med. |volume=358 |issue=4 |pages=342–52 |year=2008 |month=January |pmid=18216354 |pmc=2761092 |doi=10.1056/NEJMoa0706258 |url=}}</ref> to compare the outcomes in bare-metal versus drug-elting stents for off-label indications showed that one year after intervention, there were no significant differences in the adjusted risk of death or myocardial infarction in patients with drug-eluting stents as compared with those with bare-metal stents. These findings suggest that the poorer outcome observed after stenting for off-label indications are related to patient and lesion characteristics but not to the stent itself. | A study by Marroquin et al<ref name="pmid18216354">{{cite journal |author=Marroquin OC, Selzer F, Mulukutla SR, ''et al.'' |title=A comparison of bare-metal and drug-eluting stents for off-label indications |journal=N. Engl. J. Med. |volume=358 |issue=4 |pages=342–52 |year=2008 |month=January |pmid=18216354 |pmc=2761092 |doi=10.1056/NEJMoa0706258 |url=}}</ref> to compare the outcomes in bare-metal versus drug-elting stents for off-label indications showed that one year after intervention, there were no significant differences in the adjusted risk of death or myocardial infarction in patients with drug-eluting stents as compared with those with bare-metal stents. These findings suggest that the poorer outcome observed after stenting for off-label indications are related to patient and lesion characteristics but not to the stent itself. Therefore, large randomized clinical trial are needed to fully study this the use of DES for off label versus standard indications. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-in-Chief: Smita Kohli, M.D.
Overview
A number of clinical, angiographic, and procedural factors predispose to the occurrence of stent thrombosis. Predictors of stent thrombosis can be classified into anatomic variables, procedure related variables and clinical variables. A new entity which has been recently recognised and is being increasingly studied in relation to stent thrombosis is hyporesponsiveness to antiplatelet agents.
Procedure related variables:
Procedure related variables include stent underexpansion, margin dissections, incomplete wall apposition, residual inflow and outflow disease, overlapping stent, polymer materials.
Anatomic variables: Lesion-specific factors that increase the likelihood of stent thrombosis include a residual dissection at the margin of the stent, impaired flow into or out of the stent, small stent diameters (<3 mm), long stent lengths, and treatment of an acute myocardial infarction.
Clinical variables: Clinical variables include acute myocardial infarction, clopidogrel noncompliance and discontinuation, hyporesponsiveness to antiplatelet agents, diabetes mellitus, renal failure, congestive heart failure, prior radiation brachytherapy.
In addition to these, stent implantation for off-label indication(such as restenotic lesions, bypass graft lesions, left main coronary artery disease, as well as ostial, bifurcated, and totally occluded lesions) of both DES and BMS has been associated with higher rates of ischemic complications, including stent thrombosis, as compared with standard indications[1][2].
A study by Marroquin et al[3] to compare the outcomes in bare-metal versus drug-elting stents for off-label indications showed that one year after intervention, there were no significant differences in the adjusted risk of death or myocardial infarction in patients with drug-eluting stents as compared with those with bare-metal stents. These findings suggest that the poorer outcome observed after stenting for off-label indications are related to patient and lesion characteristics but not to the stent itself. Therefore, large randomized clinical trial are needed to fully study this the use of DES for off label versus standard indications.
References
- ↑ Beohar N, Davidson CJ, Kip KE; et al. (2007). "Outcomes and complications associated with off-label and untested use of drug-eluting stents". JAMA. 297 (18): 1992–2000. doi:10.1001/jama.297.18.1992. PMID 17488964. Unknown parameter
|month=ignored (help) - ↑ Win HK, Caldera AE, Maresh K; et al. (2007). "Clinical outcomes and stent thrombosis following off-label use of drug-eluting stents". JAMA. 297 (18): 2001–9. doi:10.1001/jama.297.18.2001. PMID 17488965. Unknown parameter
|month=ignored (help) - ↑ Marroquin OC, Selzer F, Mulukutla SR; et al. (2008). "A comparison of bare-metal and drug-eluting stents for off-label indications". N. Engl. J. Med. 358 (4): 342–52. doi:10.1056/NEJMoa0706258. PMC 2761092. PMID 18216354. Unknown parameter
|month=ignored (help)