TY - JOUR
T1 - Incidence, determinants and clinical impact of definite stent thrombosis on mortality in women: From the WIN-DES collaborative patient-level pooled analysis
AU - Kerkmeijer, Laura S.
AU - Claessen, Bimmer E.
AU - Baber, Usman
AU - Sartori, Samantha
AU - Chandrasekhar, Jaya
AU - Stefanini, Giulio G.
AU - Stone, Gregg W.
AU - Steg, P. Gabriel
AU - Chieffo, Alaide
AU - Weisz, Giora
AU - Windecker, Stephan
AU - Mikhail, Ghada W.
AU - Kastrati, Adnan
AU - Morice, Marie-Claude
AU - Dangas, George D.
AU - de Winter, Robbert J.
AU - Mehran, Roxana
PY - 2018
Y1 - 2018
N2 - Background: Predictors and clinical outcomes of stent thrombosis (ST) in women have not been well investigated. Present study aimed to identify predictors of definite ST and its impact on mortality in women undergoing percutaneous coronary intervention (PCI). Methods: Patient-level data of women enrolled in 26 randomized trials of DES was pooled. The study population was stratified based on the presence or absence of definite ST. Cox proportional hazards models were used to determine the predictors of definite ST. To analyze the temporal impact of definite ST on mortality Cox regression with ST entered as time-updated covariate was used. Results: Of 11,557 patients undergoing PCI with stent implantation, definite ST occurred in 105 patients (0.9%) over median follow-up of 3 years. Independent predictors of ST were age (HR 1.03 per year decrease, 95% CI 1.00–1.05; p = 0.041), diabetes mellitus (HR 2.25, 95% CI 1.27–3.99; p = 0.005), non-ST-segment elevation myocardial infarction (NSTEMI) at presentation (HR 1.97, 95% CI 1.04–3.75; p = 0.037) and stent diameter (HR 3.76 per mm decrease, 95% CI 1.66–8.53; p = 0.002). Compared to women without ST, the adjusted hazard ratios for mortality in the first 7 days, 8–30 days, and beyond 30 days from ST were 115.81 (95% CI 68.96–194.47); 37.44 (95% CI 17.31–80.98); 3.54 (95% CI 2.20–5.69), respectively. Conclusions: In this large-scale pooled analysis of women, definite ST was uncommon yet associated with substantial mortality risk, which peaked early and rapidly attenuated over time. Younger age, diabetes, NSTEMI and stent diameter were found to be predictors of ST.
AB - Background: Predictors and clinical outcomes of stent thrombosis (ST) in women have not been well investigated. Present study aimed to identify predictors of definite ST and its impact on mortality in women undergoing percutaneous coronary intervention (PCI). Methods: Patient-level data of women enrolled in 26 randomized trials of DES was pooled. The study population was stratified based on the presence or absence of definite ST. Cox proportional hazards models were used to determine the predictors of definite ST. To analyze the temporal impact of definite ST on mortality Cox regression with ST entered as time-updated covariate was used. Results: Of 11,557 patients undergoing PCI with stent implantation, definite ST occurred in 105 patients (0.9%) over median follow-up of 3 years. Independent predictors of ST were age (HR 1.03 per year decrease, 95% CI 1.00–1.05; p = 0.041), diabetes mellitus (HR 2.25, 95% CI 1.27–3.99; p = 0.005), non-ST-segment elevation myocardial infarction (NSTEMI) at presentation (HR 1.97, 95% CI 1.04–3.75; p = 0.037) and stent diameter (HR 3.76 per mm decrease, 95% CI 1.66–8.53; p = 0.002). Compared to women without ST, the adjusted hazard ratios for mortality in the first 7 days, 8–30 days, and beyond 30 days from ST were 115.81 (95% CI 68.96–194.47); 37.44 (95% CI 17.31–80.98); 3.54 (95% CI 2.20–5.69), respectively. Conclusions: In this large-scale pooled analysis of women, definite ST was uncommon yet associated with substantial mortality risk, which peaked early and rapidly attenuated over time. Younger age, diabetes, NSTEMI and stent diameter were found to be predictors of ST.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85046158547&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29691071
U2 - https://doi.org/10.1016/j.ijcard.2018.04.047
DO - https://doi.org/10.1016/j.ijcard.2018.04.047
M3 - Article
C2 - 29691071
SN - 0167-5273
VL - 263
SP - 24
EP - 28
JO - International journal of cardiology
JF - International journal of cardiology
ER -