High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis

G. Lemesle, A. Sudre, T. Modine, C. Delhaye, G. Rosey, T. Gourlay, C. Bauters, J. Lablanche

    Research output: Contribution to journalArticle

    20 Citations (Scopus)

    Abstract

    Objectives: We attempted to investigate incidence and predictors of recurrent in stent thrombosis (IST) after successful treatment of a first IST. Background: The occurrence of recurrent IST after successful treatment of a first IST may be a decisive factor for patient clinical outcome. However, incidence and predictors of recurrent IST are currently poorly described in the literature. Methods: Between 2003 and 2005, 2,190 patients underwent a percutaneous coronary intervention in our center. During a median follow-up of 19.4 months, 49 patients (2.24%) presented a first definite IST. Patients presenting with a first IST were followed during an additional median period of 40 months. Their baseline characteristics were listed and cardiovascular events especially recurrent IST as defined by the Academic Research Consortium definition were systematically indexed. Results: Altogether 39 (80%) patients were successfully treated with an effective reperfusion after percutaneous coronary intervention. Fourteen (36%) patients presented a recurrent IST and three presented multiple recurrent IST. The median occurrence time of recurrent IST was 5 days, range between 1 and 11 days. Multivariate analysis identified history of neoplasia (HR = 11.53, 95% CI 2.32-57.37, P = 0.003), residual diameter stenosis (HR = 1.15, 95% CI 1.02-1.29, P = 0.02), and residual dissection after treatment (HR = 8.78, 95% CI 1.85-41.62, P = 0.006), as independent predictors of recurrent IST. Conclusion: Recurrent IST is a frequent and early event after successful treatment of a first IST. Our results suggest that mechanical factors like residual dissection and residual diameter stenosis should be carefully tracked down. In addition, patients with multiple recurrent IST and the early time course of recurrent IST also suggest a potential role of inadequate antiplatelet therapy.
    Original languageEnglish
    Pages (from-to)470-478
    Number of pages8
    JournalCatheterization and Cardiovascular Interventions
    Volume72
    DOIs
    Publication statusPublished - 23 Jul 2008

    Fingerprint

    Stents
    Thrombosis
    Incidence
    Therapeutics
    Percutaneous Coronary Intervention
    Dissection
    Pathologic Constriction
    Reperfusion
    Multivariate Analysis

    Keywords

    • stent thrombosis
    • outcome
    • predictors
    • antiplatelet therapy
    • percutaneous coronary intervention

    Cite this

    Lemesle, G. ; Sudre, A. ; Modine, T. ; Delhaye, C. ; Rosey, G. ; Gourlay, T. ; Bauters, C. ; Lablanche, J. / High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis. In: Catheterization and Cardiovascular Interventions. 2008 ; Vol. 72. pp. 470-478.
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    abstract = "Objectives: We attempted to investigate incidence and predictors of recurrent in stent thrombosis (IST) after successful treatment of a first IST. Background: The occurrence of recurrent IST after successful treatment of a first IST may be a decisive factor for patient clinical outcome. However, incidence and predictors of recurrent IST are currently poorly described in the literature. Methods: Between 2003 and 2005, 2,190 patients underwent a percutaneous coronary intervention in our center. During a median follow-up of 19.4 months, 49 patients (2.24{\%}) presented a first definite IST. Patients presenting with a first IST were followed during an additional median period of 40 months. Their baseline characteristics were listed and cardiovascular events especially recurrent IST as defined by the Academic Research Consortium definition were systematically indexed. Results: Altogether 39 (80{\%}) patients were successfully treated with an effective reperfusion after percutaneous coronary intervention. Fourteen (36{\%}) patients presented a recurrent IST and three presented multiple recurrent IST. The median occurrence time of recurrent IST was 5 days, range between 1 and 11 days. Multivariate analysis identified history of neoplasia (HR = 11.53, 95{\%} CI 2.32-57.37, P = 0.003), residual diameter stenosis (HR = 1.15, 95{\%} CI 1.02-1.29, P = 0.02), and residual dissection after treatment (HR = 8.78, 95{\%} CI 1.85-41.62, P = 0.006), as independent predictors of recurrent IST. Conclusion: Recurrent IST is a frequent and early event after successful treatment of a first IST. Our results suggest that mechanical factors like residual dissection and residual diameter stenosis should be carefully tracked down. In addition, patients with multiple recurrent IST and the early time course of recurrent IST also suggest a potential role of inadequate antiplatelet therapy.",
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    author = "G. Lemesle and A. Sudre and T. Modine and C. Delhaye and G. Rosey and T. Gourlay and C. Bauters and J. Lablanche",
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    High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis. / Lemesle, G.; Sudre, A.; Modine, T.; Delhaye, C.; Rosey, G.; Gourlay, T.; Bauters, C.; Lablanche, J.

    In: Catheterization and Cardiovascular Interventions, Vol. 72, 23.07.2008, p. 470-478.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis

    AU - Lemesle, G.

    AU - Sudre, A.

    AU - Modine, T.

    AU - Delhaye, C.

    AU - Rosey, G.

    AU - Gourlay, T.

    AU - Bauters, C.

    AU - Lablanche, J.

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    N2 - Objectives: We attempted to investigate incidence and predictors of recurrent in stent thrombosis (IST) after successful treatment of a first IST. Background: The occurrence of recurrent IST after successful treatment of a first IST may be a decisive factor for patient clinical outcome. However, incidence and predictors of recurrent IST are currently poorly described in the literature. Methods: Between 2003 and 2005, 2,190 patients underwent a percutaneous coronary intervention in our center. During a median follow-up of 19.4 months, 49 patients (2.24%) presented a first definite IST. Patients presenting with a first IST were followed during an additional median period of 40 months. Their baseline characteristics were listed and cardiovascular events especially recurrent IST as defined by the Academic Research Consortium definition were systematically indexed. Results: Altogether 39 (80%) patients were successfully treated with an effective reperfusion after percutaneous coronary intervention. Fourteen (36%) patients presented a recurrent IST and three presented multiple recurrent IST. The median occurrence time of recurrent IST was 5 days, range between 1 and 11 days. Multivariate analysis identified history of neoplasia (HR = 11.53, 95% CI 2.32-57.37, P = 0.003), residual diameter stenosis (HR = 1.15, 95% CI 1.02-1.29, P = 0.02), and residual dissection after treatment (HR = 8.78, 95% CI 1.85-41.62, P = 0.006), as independent predictors of recurrent IST. Conclusion: Recurrent IST is a frequent and early event after successful treatment of a first IST. Our results suggest that mechanical factors like residual dissection and residual diameter stenosis should be carefully tracked down. In addition, patients with multiple recurrent IST and the early time course of recurrent IST also suggest a potential role of inadequate antiplatelet therapy.

    AB - Objectives: We attempted to investigate incidence and predictors of recurrent in stent thrombosis (IST) after successful treatment of a first IST. Background: The occurrence of recurrent IST after successful treatment of a first IST may be a decisive factor for patient clinical outcome. However, incidence and predictors of recurrent IST are currently poorly described in the literature. Methods: Between 2003 and 2005, 2,190 patients underwent a percutaneous coronary intervention in our center. During a median follow-up of 19.4 months, 49 patients (2.24%) presented a first definite IST. Patients presenting with a first IST were followed during an additional median period of 40 months. Their baseline characteristics were listed and cardiovascular events especially recurrent IST as defined by the Academic Research Consortium definition were systematically indexed. Results: Altogether 39 (80%) patients were successfully treated with an effective reperfusion after percutaneous coronary intervention. Fourteen (36%) patients presented a recurrent IST and three presented multiple recurrent IST. The median occurrence time of recurrent IST was 5 days, range between 1 and 11 days. Multivariate analysis identified history of neoplasia (HR = 11.53, 95% CI 2.32-57.37, P = 0.003), residual diameter stenosis (HR = 1.15, 95% CI 1.02-1.29, P = 0.02), and residual dissection after treatment (HR = 8.78, 95% CI 1.85-41.62, P = 0.006), as independent predictors of recurrent IST. Conclusion: Recurrent IST is a frequent and early event after successful treatment of a first IST. Our results suggest that mechanical factors like residual dissection and residual diameter stenosis should be carefully tracked down. In addition, patients with multiple recurrent IST and the early time course of recurrent IST also suggest a potential role of inadequate antiplatelet therapy.

    KW - stent thrombosis

    KW - outcome

    KW - predictors

    KW - antiplatelet therapy

    KW - percutaneous coronary intervention

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