Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients

Objective: We sought to determine the incidence, angiographic predictors, and impact of stent thrombosis (ST).

Background: Given the high mortality after ST, this study emphasises the importance of ongoing efforts to identify angiographic predictors of ST.

Methods: All consecutive patients with angiographically confirmed ST between 2010 and 2016 were 1:4 matched for (1) percutaneous coronary intervention (PCI) indication and (2) index date ±6 weeks to randomly selected controls. Index PCI angiograms were reassessed by two independent cardiologists. A multivariable conditional logistic regression model was built to identify independent predictors of ST.

Results: Of 6,545 consecutive patients undergoing PCI, 55 patients [0.84%, 95% confidence interval (CI) 0.63-1.10%] presented with definite ST. Multivariable logistic regression identified dual antiplatelet therapy (DAPT) non-use as the strongest predictor of ST (odds ratio (OR) 10.9, 95% CI 2.47-48.5, p < 0.001), followed by: stent underexpansion (OR 5.70, 95% CI 2.39-13.6, p < 0.001), lesion complexity B2/C (OR 4.32, 95% CI 1.43-13.1, p = 0.010), uncovered edge dissection (OR 4.16, 95% CI 1.47-11.8, p = 0.007), diabetes mellitus (OR 3.23, 95% CI 1.25-8.36, p = 0.016), and residual coronary artery disease at the stent edge (OR 3.02, 95% CI 1.02-8.92, p = 0.045). ST was associated with increased rates of mortality as analysed by Kaplan-Meier estimates (27.3 vs 11.3%, p_log-rank < 0.001) and adjusted Cox proportional-hazard regression (hazard ratio 2.29, 95% CI 1.03-5.10, p = 0.042).

Conclusions: ST remains a serious complication following PCI with a high rate of mortality. DAPT non-use was associated with the highest risk of ST, followed by various angiographic parameters and high lesion complexity.