Pacheco GG, Obregón SÁG, Aroche AR, Conde CH, Hernández NM, Gandarilla SJC

Language: Spanish
References: 20
Page: 97-102
PDF size: 210.44 Kb.

ABSTRACT

Introduction and Objectives: Stent thrombosis is a complication after percutaneous coronary intervention associated with high mortality and morbidity. Despite the use of dual antiplatelet therapy (aspirin and clopidogrel) and optimization of the technique, its incidence has not disappeared. The objective of this research was to determine the risk factors for thrombosis of the bare metal stents. Method: A retrospective descriptive study was performed. Out of the 2,014 revascularized arteries at the Medical-Surgical Research Center in Havana, Cuba, between August 1997 and February 2009, the 289 redo ones were selected. Results: thrombosis of the conventional metal stents was present in 20 arteries, of which 11 corresponded to the anterior descending artery, and the highest incidence occurred in the first 24 hours and after 30 days. Diabetes mellitus was a risk factor for thrombosis (OR = 3.06) and the release pressure of less than 10 atmospheres (OR = 3.70) and complex lesions of types B₂ and C (OR = 8.80), all with statistical significance (p ‹ 0.05). Conclusions: The highest incidence of bare metal stent thrombosis was on the first day of revascularization after the termination of dual antiplatelet therapy and located in the anterior descending artery. Diabetes mellitus, complex lesions and low pressures of stent release, behaved as risk factors for thrombosis with statistically significant results.

REFERENCES

1. Balaguer-Malfagón JR, Pomar-Domingo F, Vilar-Herrero JV, Planas-del Viejo AM, Pérez-Fernández E. Trombosis del stent en la era moderna: inci-dencia, consecuencias y factores predictores. Rev Esp Cardiol. 2006;59(8):842-5.

2. Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ. Stent Thrombosis in the Modern Era: A Pooled Analysis of Multicenter Coronary Stent Cli-nical Trials. Circulation. 2001;103;1967-71.

3. Applegate RJ, Sacrinty MT, Kutcher MA, Santos RM, Gandhi SK, Baki TT, et al. “Off-label” stent therapy 2-year comparison of drug-eluting versus bare-metal stents. J Am Coll Cardiol. 2008;51(6): 607-14.

4. Íñiguez Romo A. Trombosis de los stents farma-coactivos. Rev Esp Cardiol. 2008;61(7):674-7.

5. US Food and Drug Administration [sitio web en Internet]. Silver Spring; 2006 [actualizado 21 Dic 2008]. Disponible en: http://www.fda.gov/ohrms/dockets/ac/cdrh06.html#circulatory

6. Pfisterer M, Brunner-La Rocca HP, Buser PT, Rickenbacher P, Hunziker P, Mueller C, et al. Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an obser-vational study of drug-eluting versus bare-metal stents. J Am Coll Cardiol. 2006;48(12):2584-91.

7. Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern. Circulation. 2007;115(11):1440-55.

8. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, et al. Clinical end points in coronary stent trials: a case for standardized defi-nitions. Circulation. 2007;115(17):2344-51.

9. Mauri L, Hsieh WH, Massaro JM, Ho KK, D’Agos-tino R, Cutlip DE. Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med. 2007;356:1020-9.

10. Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet. 2007;369 (9562):619-21.

11. Joner M, Finn AV, Farb A, Mont EK, Kolodgie FD, Ladich E, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006;48(1):193-202.

12. Bavry AA, Bhatt DL. Appropriate use of drug-eluting stents: balancing the reduction in restenosis with the concern of late thrombosis. Lancet. 2008; 371(9630):2134-43.

13. Jaffe R, Strauss BH. Late and very late thrombosis of drug-eluting stents evolving concepts and pers-pectives. J Am Coll Cardiol. 2007;50 (2):119-27.

14. Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS, et al. Prevalence, predic-tors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation. 2006;113(24):2803-9.

15. Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA. 2007;297(2):159-68.

16. Jiménez- Quevedo P, Sabaté M, Angiolillo DJ, Alfonso F, Hernández-Antolín R, Gómez-Hospital JA, et al. Eficacia de la implantación del stent recubierto de rapamicina en pacientes diabéticos con vasos muy pequeños (menor e igual a 2,25 mm). Subanálisis del estudio DIABETES. Rev Esp Cardiol. 2006;59(10):1000-7.

17. Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC, Schömig A, et al. Outcomes associated with drug-eluting and bare-metal stents: a colla-borative network meta-analysis. Lancet. 2007; 370(9591):937-48.

18. Doyle B, Rihal CS, O’Sullivan CJ, Lennon RJ, Wiste HJ, Bell M, et al. Outcomes of stent throm-bosis and restenosis during extended follow-up of patients treated with bare-metal coronary stents. Circulation. 2007(21);116:2391-8.

19. Wiviott SD, Braunwald E, McCabe CH, Horvath I, Keltai M, Herrman JP, et al; TRITON-TIMI 38 Investigators. Intensive oral antiplatelet therapy for reduction of ischaemic events including stent thrombosis in patients with acute coronary syn-dromes treated with percutaneous coronary inter-vention and stenting in the TRITON-TIMI 38 trial: a subanalysis of a randomised trial. Lancet. 2008; 371(9621):1353-63.

20. Ge L, Airoldi F, Iakovou I, Cosgrave J, Michev I, Sangiorgi GM, et al. Clinical and angiographic outcome after implantation of drug-eluting stents in bifurcation lesions with the crush stent technique: importance of final kissing balloon postdilation. J Am Coll Cardiol. 2005;46(4):613-20.