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Coronary artery stent thrombosis: Incidence and risk factors

Donald Cutlip, MD
J Dawn Abbott, MD, FACC
Section Editors
Christopher P Cannon, MD
Stephan Windecker, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Coronary artery stents are used in the majority of patients who undergo percutaneous coronary intervention (PCI), as they significantly reduce the need for repeat target vessel revascularization compared to balloon angioplasty. (See "Intracoronary stent restenosis", section on 'Incidence of restenosis'.)

Stent thrombosis is an uncommon but serious complication that almost always presents as death or a large non-fatal myocardial infarction (MI), usually with ST elevation. It is estimated that less than 10 percent of cardiac deaths after stent placement are attributable to stent thrombosis, with most of the remainder being due to disease progression [1]. This issue is discussed in detail separately. (See "Clinical use of intracoronary bare metal stents", section on 'BMS compared with DES'.)

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 similar frequency in patients with bare metal stents (BMS) or drug-eluting stents (DES), as long as patients are treated with dual antiplatelet therapy (aspirin plus a platelet P2Y12 receptor blocker) for the recommended duration. The period of risk requiring dual antiplatelet therapy (DAPT) is longer with DES, due at least in part to delayed neointimal coverage, although this difference is decreasing with newer generation DES. (See 'Very late stent thrombosis' below.)

General issues related to stent thrombosis will be reviewed in this topic. The prevention and management of stent thrombosis are discussed separately. (See "Long-term antiplatelet therapy after coronary artery stenting in stable patients" and "Coronary artery stent thrombosis: Clinical presentation and management".)


Although earlier clinical trials posed a problem for comparing stent thrombosis rates due to non-standardized definition, since 2007 most trials have adopted the criteria and classification proposed by the Academic Research Consortium (ARC) [2].

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Literature review current through: Nov 2017. | This topic last updated: Aug 18, 2016.
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