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Multicenter Study
. 2021 May 4;10(9):e018972.
doi: 10.1161/JAHA.120.018972. Epub 2021 Apr 17.

Risk Factors and Outcomes of Recurrent Drug-Eluting Stent Thrombosis: Insights From the REAL-ST Registry

Soichiro Enomoto  1 , Shoichi Kuramitsu  2 , Tomohiro Shinozaki  3 , Masanobu Ohya  4 , Hiromasa Otake  5 , Futoshi Yamanaka  6 , Hiroki Shiomi  7 , Masahiro Natsuaki  8 , Gaku Nakazawa  9 , Kenji Ando  2 , Kazushige Kadota  4 , Shigeru Saito  6 , Toshihiro Tamura  1 , Takeshi Kimura  7 ; REAL‐ST investigators †
Collaborators, Affiliations
Multicenter Study

Risk Factors and Outcomes of Recurrent Drug-Eluting Stent Thrombosis: Insights From the REAL-ST Registry

Soichiro Enomoto et al. J Am Heart Assoc. .

Abstract

Background Stent thrombosis (ST) after drug-eluting stent (DES) implantation remains a life-threatening complication. Recurrent ST (RST) is not a rare phenomenon, potentially contributing to high mortality after the index ST events. However, little evidence is available about the incidence, risk factors, and clinical outcomes of definite RST after DES thrombosis. Methods and Results From REAL-ST (Retrospective Multicenter Registry of ST After First- and Second- Generation DES Implantation), this study evaluated 595 patients with definite ST (first-generation DES thrombosis, n=314; second-generation DES thrombosis, n=281). During a median follow-up of 31 months, we identified 32 patients with definite RST after first-generation DES thrombosis (n=18) and second-generation DES thrombosis (n=15). Cumulative incidence of RST was 4.5% and 6.0% at 1 and 5 years, respectively, which did not significantly differ between first-generation DES thrombosis and second-generation DES thrombosis. Independent predictors of definite RST were early ST (hazard ratio [HR], 2.38; 95% CI, 1.06-5.35 [P=0.035]) and multivessel ST (HR, 3.47; 95% CI, 1.03-11.7 [P=0.044]). Definite RST was associated with a 2.8-fold increased risk of mortality (adjusted HR, 2.78; 95% CI, 1.35-5.73 [P=0.006]). Conclusions Cumulative incidence of definite RST did not significantly differ between first-generation DES thrombosis and second-generation DES thrombosis. Early ST and multivessel ST were risk factors of definite RST. Definite RST significantly increased mortality after DES thrombosis, highlighting the clinical importance of preventing RST to improve outcomes of patients with ST. Registration URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000025181.

Keywords: drug‐eluting stent; percutaneous coronary intervention; recurrent stent thrombosis.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. Cumulative incidence of recurrent stent thrombosis (ST).
Figure 2
Figure 2. Comparison of incidence of recurrent stent thrombosis (RST) after first‐generation drug‐eluting stent thrombosis (G1‐ST) and second‐generation drug‐eluting stent thrombosis (G2‐ST).
ST indicates stent thrombosis. A, Early ST (EST), (B) late ST (LST), and (C) very late ST (VLST).
Figure 3
Figure 3. Risk factors associated with recurrent stent thrombosis (ST).
EST indicates early stent thrombosis; HR, hazard ratio; LST, late stent thrombosis; ST, stent thrombosis; and VLST, vary late stent thrombosis.
Figure 4
Figure 4. Survival probabilities before and after recurrent stent thrombosis (RST) development. ST indicates stent thrombosis.
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