de la Torre-Hernández, José M., Alfonso, Fernando, Hernández, Felipe, Elizaga, Jaime, Sanmartin, Marcelo, Pinar, Eduardo, Lozano, Iñigo, Vazquez, Jose M., Botas, Javier, Perez de Prado, Armando, Hernández, Jose M., Sanchis, Juan, Ruiz Nodar, Juan M., Gomez-Jaume, Alfredo, Larman, Mariano, Diarte, Jose A., Rodríguez-Collado, Javier, Rumoroso, Jose R., Lopez-Minguez, Jose R., and Mauri, Josepa
Objectives: This study sought to assess the incidence, predictors, and outcome of drug-eluting stent(DES) thrombosis in real-world clinical practice. Background: The DES thromboses in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications. Methods: We designed a large-scale, nonindustry-linked multicentered registry, with 20 centers in Spain. The participant centers provided follow-up data for their patients treated with DES, reporting a detailed standardized form in the event of any angiography-documented DES-associated thrombosis occurring. Results: Of 23,500 patients treated with DES, definite stent thrombosis(ST) developed in 301: 24 acute, 125 subacute, and 152 late. Of the late, 62 occurred >1 year(very late ST). The cumulative incidence was 2% at 3 years. Antiplatelet treatment had been discontinued in 95 cases(31.6%). No differences in incidences were found among stent types. Independent predictors for subacute ST analyzed in a subgroup of 14,120 cases were diabetes, renal failure, acute coronary syndrome, ST-segment elevation myocardial infarction, stent length, and left anterior descending artery stenting, and for late ST were ST-segment elevation myocardial infarction, stenting in left anterior descending artery, and stent length. Mortality at 1-year follow-up was 16% and ST recurrence 4.6%. Older age, left ventricular ejection fraction <45%, nonrestoration of Thrombolysis In Myocardial Infarction flow grade 3, and additional stenting were independent predictors for mortality. Conclusions: The cumulative incidence of ST after DES implantation was 2% at 3 years. No differences were found among stent types. Patient profiles differed between early and late ST. Short-term prognosis is poor, especially when restoration of normal flow fails. [Copyright &y& Elsevier]