Department of Cardiovascular of Medicine, Kyoto University, Japan.
Circulation. 2010 Jul 6;122(1):52-61. doi: 10.1161/CIRCULATIONAHA.109.903955. Epub 2010 Jun 21.
Stent thrombosis (ST) after sirolimus-eluting stent implantation has not yet been adequately characterized, mainly because of its low incidence.
The Registry of Stent Thrombosis for Review and Reevaluation (RESTART) is a Japanese nationwide registry of sirolimus-eluting stent-associated ST comprising 611 patients with definite ST (early [within 30 days; EST], 322 patients; late [between 31 and 365 days; LST], 105 patients; and very late [>1 year; VLST], 184 patients). Baseline demographics, clinical presentation, and long-term outcome of sirolimus-eluting stent-associated ST were compared among patients with EST, LST, and VLST. Baseline demographics were significantly different according to the timing of ST. Characteristic demographic factors for LST/VLST versus EST identified by multivariable model were hemodialysis, end-stage renal disease not on hemodialysis, absence of circumflex target, target of chronic total occlusion, prior percutaneous coronary intervention, and age <65 years. For LST versus VLST, they were hemodialysis, heart failure, insulin-dependent diabetes mellitus, and low body mass index. Patients with LST had a significantly higher rate of Thrombolysis in Myocardial Infarction grade 2/3 flow (36%) at the time of ST than those with EST (13%) (P<0.0001) and VLST (17%; P<0.0001). Mortality rate at 1 year after ST was significantly lower in patients with VLST (10.5%) compared with those with EST (22.4%; P=0.003) or LST (23.5%; P=0.009).
ST timing-dependent differences in baseline demographic features, Thrombolysis in Myocardial Infarction flow grade, and mortality rate suggest possible differences in the predominant pathophysiological mechanisms of ST according to timing after sirolimus-eluting stent implantation.
尽管西罗莫司洗脱支架置入后发生支架血栓（ST）的情况并不常见，但目前仍缺乏对其全面的认识。
支架血栓注册研究（RESTART）是一项日本全国范围内的西罗莫司洗脱支架相关 ST 注册研究，共纳入 611 例明确诊断为 ST 的患者（早期[30 天内；EST]，322 例；晚期[31-365 天；LST]，105 例；极晚期[>1 年；VLST]，184 例）。比较 EST、LST 和 VLST 患者的基线人口统计学特征、临床表现和长期预后。ST 发生时间不同，患者的基线人口统计学特征也存在显著差异。多变量模型识别出 LST/VLST 与 EST 相比的特征性人口统计学因素为血液透析、非血液透析终末期肾病、无回旋支靶病变、慢性完全闭塞靶病变、既往经皮冠状动脉介入治疗和年龄<65 岁。对于 LST 与 VLST 相比，这些因素为血液透析、心力衰竭、胰岛素依赖型糖尿病和低体重指数。发生 ST 时，LST 患者 TIMI 血流分级 2/3 级的比例（36%）显著高于 EST 患者（13%）（P<0.0001）和 VLST 患者（17%）（P<0.0001）。ST 后 1 年死亡率在 VLST 患者（10.5%）显著低于 EST 患者（22.4%）（P=0.003）和 LST 患者（23.5%）（P=0.009）。
基于 ST 发生时间的不同，患者的基线人口统计学特征、TIMI 血流分级和死亡率存在差异，提示西罗莫司洗脱支架置入后 ST 可能存在不同的主要病理生理机制。
