Angiographic Stent Thrombosis at Coronary Bifurcations: Short- and Long-Term Prognosis

详细信息    查看全文

• 作者：Ehrin J. Armstrong ; MD^?/sup> ; Khung Keong Yeo ; MBBS^?/sup> ; Usman Javed ; MD^?/sup> ; Ehtisham Mahmud ; MD^&dagger ; ; Mitul Patel ; MD^&dagger ; ; Kendrick A. Shunk ; MD^&Dagger ; ; ^§ ; ; John S. MacGregor ; MD ; PhD^&Dagger ; ; ^?/sup> ; Reginald I. Low ; MD^?/sup> ; Jason H. Rogers ; MD^?/sup> ; ^{jason.rogers@ucdmc.ucdavis.edu}
• 关键词：bifurcation ; stent thrombosis ; thrombus
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2012
• 出版时间：January, 2012
• 年：2012
• 卷：5
• 期：1
• 页码：57-63
• 全文大小：441 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Objectives

This study sought to describe the presentation, management, and outcomes of patients presenting with angiographic definite stent thrombosis (ST) at coronary bifurcations.

Background

The development of drug-eluting stents has made it increasingly feasible to treat bifurcation lesions percutaneously. However, ST at coronary bifurcations may be associated with greater mortality than ST elsewhere.

Methods

We analyzed a multicenter California registry comprising all cases of angiographic definite ST at 5 academic hospitals from 2005 to 2010. Stenting was defined as occurring at a bifurcation if the main vessel stent crossed a side branch ?.0 mm in diameter (provisional single-stent approach), or if there was a prior 2-stent bifurcation approach.

Results

Among 173 cases of angiographic definite ST, we identified 20 cases of ST at coronary bifurcations. Nine of 20 bifurcation ST (45 % ) occurred with a stent present in both the parent and branch vessel. Eight cases had thrombus present in both the parent and side branch vessels. In-hospital mortality was much higher for subjects with bifurcation ST than ST at a nonbifurcation site (20 % vs. 2 % , p < 0.0001). During a median follow-up of 2.3 years, ST at a coronary bifurcation was associated with increased long-term mortality (hazard ratio [HR]: 3.3, 95 % confidence interval [CI]: 1.4 to 7.7, p = 0.007) and a significantly higher risk for major adverse cardiovascular events (HR: 2.2, 95 % CI: 1.04 to 4.8, p = 0.04) relative to ST at a nonbifurcation site.

Conclusions

ST at coronary bifurcations is associated with a higher in-hospital and long-term mortality than ST at nonbifurcation lesions. (Stent Thrombus in Acute Coronary Syndromes; )