Stent thrombosis: a poor man's disease?

BACKGROUND

Stent thrombosis is a rare but devastating complication of coronary stent implantation. The incidence and potential predictors were assessed in a "real world" single center.

OBJECTIVES

To examine whether socioeconomic status indeed affects the occurrence of stent thrombosis.

METHODS

We searched our database for cases of "definite" stent thrombosis (according to the ARC Dublin definitions). Each case was matched by procedure date, age and gender with three cases of stenting that did not result in stent thrombosis. Demographic and clinical parameters were compared and socioeconomic status was determined according to a standardized polling and market survey database.

RESULTS

A total of 3401 patients underwent stent implantation in our hospital during the period 2004-2006. Their mean age was 63 +/- 11 years, and 80% were males. Twenty-nine cases (0.85%) of "definite" sub-acute/late stent thrombosis were recorded. Mortality at 30 days was recorded in 1 patient (3.5%). Thrombosis occurred 2 days to 3 years after stent implantation. All patients presented with acute myocardial infarction. Premature clopidogrel discontinuation was reported in 60%. Patients with stent thrombosis had significantly higher rates of AMI at the time of the initial procedure (76 vs. 32%, P < 0.001) and were cigarette smokers (60 vs. 28%, P < 0.001). Drug-eluting stents were used less in the stent thrombosis group. There was no difference in stent diameter or length between the two groups. Socioeconomic status was significantly lower in the stent thrombosis group, 3.4 +/- 2.4 vs. 5.4 +/- 2.6 (mean +/- SD, scale 1-10, P < 0.01).

CONCLUSIONS

The incidence rate of stent thrombosis is at least 0.85% in our population. It appears in patients with significantly lower socioeconomic status and with certain clinical predictors. These results warrant stricter follow-up and support the policy of healthcare providers regarding patients at risk for stent thrombosis.