Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan.
Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita Japan.
J Am Heart Assoc. 2022 Apr 5;11(7):e023276. doi: 10.1161/JAHA.121.023276. Epub 2022 Apr 4.
Background Stent thrombosis (ST) remains a significant medical issue. In particular, longer-term mortality and clinical predictors after ST occurrence have yet to be elucidated. Methods and Results This was a multicenter, retrospective, observational study. A total of 187 definite ST cases from January 2008 to December 2017 were enrolled, and the long-term clinical outcomes were investigated. The primary outcome measure was the cumulative mortality after ST occurrence. In addition, independent predictors of mortality were assessed. Among the stent types causing ST, bare-metal stent, first-generation drug-eluting stent, second-generation drug-eluting stent, and third-generation drug-eluting stent comprised 31.0%, 19.3%, 36.9%, and 6.4% of cases, respectively. Median duration from stent implantation to ST was 680.5 (interquartile range, 33.8-2450.5) days. Cumulative mortality was 14.6%, 17.4%, 21.2%, 24.4%, and 33.8% at 1, 2, 3, 5 and 10 years, respectively. The cumulative mortality did not significantly differ by type of stent, and mortality of late ST was higher than that of early ST and very late ST; however, it did not reach statistical significance after the multivariate analysis. Independent predictors of mortality were hemodialysis (hazard ratio [HR], 7.80; 95% CI, 3.07-19.81; <0.001), culprit lesions in the left main trunk (HR, 8.14; 95% CI, 1.71-38.75; =0.008), culprit lesions in the left coronary artery (HR, 2.77; 95% CI, 1.10-6.96; =0.030), and peak creatine kinase (HR, 1.017; 95% CI, 1.011-1.022; <0.001). Conclusions The 10-year cumulative mortality after ST reached 33.8%. Close follow-up is thus mandatory for patients with ST, especially with hemodialysis, culprit lesions in the left main trunk and left coronary artery, and high peak creatine kinase.
支架血栓（ST）仍然是一个重大的医学问题。特别是，ST 发生后的长期死亡率和临床预测因素仍有待阐明。
这是一项多中心、回顾性、观察性研究。共纳入 2008 年 1 月至 2017 年 12 月期间 187 例明确的 ST 病例，对其长期临床结局进行了研究。主要观察终点是 ST 发生后的累积死亡率。此外，还评估了死亡率的独立预测因素。导致 ST 的支架类型中，裸金属支架、第一代药物洗脱支架、第二代药物洗脱支架和第三代药物洗脱支架分别占 31.0%、19.3%、36.9%和 6.4%。支架植入至 ST 的中位时间为 680.5（四分位距 33.8-2450.5）天。1、2、3、5 和 10 年的累积死亡率分别为 14.6%、17.4%、21.2%、24.4%和 33.8%。支架类型与死亡率之间无显著差异，晚期 ST 的死亡率高于早期 ST 和极晚期 ST，但多变量分析后无统计学意义。死亡率的独立预测因素包括血液透析（危险比 [HR]，7.80；95%CI，3.07-19.81；<0.001）、左主干罪犯病变（HR，8.14；95%CI，1.71-38.75；=0.008）、左冠状动脉罪犯病变（HR，2.77；95%CI，1.10-6.96；=0.030）和肌酸激酶峰值（HR，1.017；95%CI，1.011-1.022；<0.001）。
ST 发生后 10 年的累积死亡率达到 33.8%。因此，对于 ST 患者，尤其是血液透析、左主干和左冠状动脉罪犯病变以及肌酸激酶峰值较高的患者，必须进行密切随访。
