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Coronary artery stent thrombosis: General issues

INTRODUCTION

Coronary artery stents, particularly drug-eluting stents (DES), are used in the majority of patients who undergo percutaneous coronary intervention (PCI). Stent thrombosis is an uncommon but serious complication of coronary artery stents that almost always presents as death or a large non-fatal myocardial infarction (MI), usually with ST elevation.

Stent thrombosis can occur acutely (within 24 hours), subacutely (within 30 days), or as late as one year (late) or more (very late) after stent placement. Stent thrombosis within the first year appears to occur with equal frequency in patients with bare metal stents (BMS) or DES, as long as patients with DES are treated with dual antiplatelet therapy (aspirin plus clopidogrel, ticlopidine, or prasugrel) for the recommended duration.

The period of risk requiring dual antiplatelet therapy (DAT) is longer with DES due at least in part to delayed neointimal coverage. There is increasing concern that the risk for very late stent thrombosis is slightly higher with DES than BMS, and it is unknown if longer term DAT reduces this risk. (See 'Delayed neointimal coverage' below and 'Long-term comparison of DES and BMS' below.)

General issues related to stent thrombosis will be reviewed here. The prevention and management of stent thrombosis, the use of antithrombotic therapy, including antiplatelet drugs, in the periprocedural period, death and myocardial infarction after stent placement, and stent restenosis are discussed separately. (See "Coronary artery stent thrombosis: Prevention and management" and "Antithrombotic therapy for intracoronary stent implantation: General use", section on 'Aspirin' and "Antithrombotic therapy for intracoronary stent implantation: General use", section on 'Clopidogrel' and "Use of drug-eluting intracoronary stents", section on 'Death or MI after DES placement' and "Intracoronary stent restenosis".)

DEFINITIONS

The randomized clinical trials that have evaluated the frequency of stent thrombosis have not used a uniform definition in their protocols, leading to difficulty in comparing the different studies. The following definitions were used in most studies and, for the purpose of this discussion, will be called the protocol definition [1]:

                     

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Literature review current through: 20.6: May 2012
This topic last updated: Dec 18, 2011
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