European Heart Journal Advance Access originally published online on November 5, 2008
European Heart Journal 2008 29(24):3011-3021; doi:10.1093/eurheartj/ehn479
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Angiographic and clinical outcome of invasively managed patients with thrombosed coronary bare metal or drug-eluting stents: the OPTIMIST study
1 Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
2 U.O. of Interventional Cardiology, A.O. San Camillo-Forlanini Hospital, Rome, Italy
3 Department of Cardiology, San Filippo Neri Hospital, Rome, Italy
4 Catheterization Laboratory, S. Giovanni Hospital, Rome, Italy
5 Department of Cardiology, San Pietro FBF Hospital, Rome, Italy
6 Department of Cardiovascular and Respiratory Sciences, Policlinico Umberto I, ‘La Sapienza’ University, Rome, Italy
7 UOSD Emodinamica e Cardiologia Interventistica, ‘Sandro Pertini’ Hospital, Rome, Italy
8 U.O.C. of Cardiology, S. Spirito Hospital, Rome, Italy
9 U.O. Cardiologia Invasiva e Interventistica Endovascolare, S. Carlo—I.D.I. Hospital, Rome, Italy
10 Catheterization Laboratory, Division of Cardiology, Policlinico Casilino Hospital, Rome, Italy
Received 4 January 2008; revised 1 September 2008; accepted 9 October 2008; online publish-ahead-of-print 5 November 2008.
* Corresponding author. Tel: +39 0349 4295290, Fax: +39 06 3055535, Email: f.burzotta{at}rm.unicatt.it
Aims: Stent thrombosis (ST) is a major complication of percutaneous coronary interventions (PCIs). An invasive management by re-PCI is the commonly adopted treatment for ST, but data on outcome are limited.
Methods and results: We performed a 2-year multicentre registry enrolling consecutive patients with angiographically confirmed ST undergoing PCI. The primary angiographic endpoint was optimal angiographic reperfusion (TIMI 3 + blush grade 2 or 3). The primary clinical endpoints were death and major adverse coronary and cerebrovascular events (MACCEs) at 6 months. A total of 110 patients underwent 117 urgent PCI during the study. Patients with drug-eluting stent (DES) thrombosis, compared with those with bare metal stent (BMS) thrombosis, exhibited a higher rate of late or very late presentation and of anti-platelet therapy withdrawal. Optimal angiographic reperfusion was obtained in 64% of the patients. Death and MACCE rates at 6 months were 17 and 30%, respectively. Clinical outcome was similar for BMS and DES thrombosis. Very late ST, implantation of stent during PCI for ST, and failure to achieve optimal angiographic reperfusion were the independent predictors of 6-month mortality.
Conclusion: DES and BMS thromboses have different clinical features, but a similar poor outcome. Indeed, PCI for ST is associated with a low rate of reperfusion and to a high rate of death and MACCE, calling for action in order to prevent its occurrence and to improve its management.
Key Words: PCI • Stent • Stent thrombosis