European Heart Journal Advance Access originally published online on July 11, 2009
European Heart Journal 2009 30(22):2714-2721; doi:10.1093/eurheartj/ehp275
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Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period
1 Deutsches Herzzentrum, Technische Universität, Lazarettstr. 36, 80636 Munich, Germany
2 Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität, Munich, Germany
3 First Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany
Received 5 November 2008; revised 13 February 2009; accepted 12 June 2009; online publish-ahead-of-print 11 July 2009.
* Corresponding author. Tel: +49 89 1218 1534, Fax: +49 89 1218 1539, Email: schulzs{at}dhm.mhn.de
See page 2685 for the editorial comment on this article (doi:10.1093/eurheartj/ehp436)
Aims: To assess the incidence, timing, and relation of drug-eluting stent (DES) thrombosis to discontinuation of clopidogrel therapy.
Methods and results: This prospective observational cohort study included 6816 consecutive patients that underwent successful DES implantation. Primary endpoint was definite stent thrombosis (ST). During 4 years of follow-up, definite ST was observed in 73 patients, corresponding to a cumulative incidence of 1.2%. Cumulative incidence of ST at 30 days was 0.5 and 0.8% at 1 year, respectively. Discontinuation of clopidogrel therapy was significantly associated with ST only in the first 6 months after the procedure (P < 0.001). During that period, the median time interval from clopidogrel discontinuation to ST was 9 days [interquartile range (IQR) 5.5–22.5] while thereafter it was 104.3 days (IQR 7.4–294.8).
Conclusion: The 4 year incidence of ST after DES implantation is low. A relevant number of ST occur early after discontinuation of clopidogrel therapy. The dependence of ST on discontinuation of clopidogrel therapy seems to be mostly confined to the first 6 months after DES implantation. However, specifically designed randomized studies are required to establish the optimal length of clopidogrel therapy after DES implantation.
Key Words: Stent thrombosis • Drug-eluting stent • Clopidogrel
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EHJ 2009 10.1093/eurheartj/ehp436.[Extract] [Full Text]
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  S. Schulz and A. Kastrati Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period: reply Eur. Heart J., January 27, 2010; (2010): ehq004v1 - ehq004. [Full Text] [PDF]
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X. Flores-Rios, G. Aldama-Lopez, R. A Calvino-Santos, N. Vazquez-Gonzalez, and A. Castro-Beiras Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period Eur. Heart J., January 27, 2010; (2010): ehq003v1 - ehq003. [Full Text] [PDF]
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G. Montalescot, J.-S. Hulot, and J.-P. Collet Stent thrombosis: who's guilty? Eur. Heart J., November 2, 2009; 30(22): 2685 - 2688. [Full Text] [PDF]
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