Angiographic predictors of 2-year stent thrombosis in patients receiving drug-eluting stents

Insights from the ADAPT-DES study

Philippe Genereux, Björn Redfors, Bernhard Witzenbichler, Akiko Maehara, Mayank Yadav, Giora Weisz, Dominic P. Francese, Rupa Parvataneni, Sorin J. Brener, Roxana Mehran, Ajay J. Kirtane, Gregg W. Stone

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives: We sought to identify angiographic predictors of 2-year stent thrombosis (ST) in the ADAPT-DES study. Background: A strong relationship between platelet reactivity and ST after implantation of drug-eluting stents (DES) was recently confirmed in the prospective, multicenter ADAPT-DES study. Methods: In a pre-specified analysis of patients enrolled in ADAPT-DES, an independent angiographic core laboratory performed detailed angiographic analyses for all cases of ST. Patients with Academic Research Consortium definite/probable target-lesion ST were matched with controls in a 1:2 ratio, and multivariable Cox regression models identified angiographic predictors of 2-year ST. Results: Among 8,582 patients who had successful percutaneous coronary intervention (PCI) and were included in the ADAPT-DES study, 92 (1.1%) patients had ST at 2-year follow-up. Target lesion-related ST was identified in 77 patients (82 lesions) who were clinically matched with 153 patients (196 lesions) without ST. Patients with ST were more likely to have longer target lesions, thrombus, moderate/severe calcification, American College of Cardiology/American Heart Association (ACC/AHA) type C lesions, and saphenous vein grafts. After adjustment for clinical covariates the angiographic variables that predicted ST were lesion complexity (ACC/AHA type C lesion, adjusted HR: 1.97, 95% CI: 1.19 to 3.26, P = 0.01) and presence of thrombus on index PCI (HR: 2.25, 95% CI: 1.40 to 3.59, P < 0.01). Conclusions: Anatomically complex lesions and the presence of thrombus are strong predictors of 2-year ST in the DES era.

Original languageEnglish (US)
Pages (from-to)26-35
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume89
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Drug-Eluting Stents
Stents
Thrombosis
Percutaneous Coronary Intervention
American Heart Association
Saphenous Vein
Cardiology
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, Philippe ; Redfors, Björn ; Witzenbichler, Bernhard ; Maehara, Akiko ; Yadav, Mayank ; Weisz, Giora ; Francese, Dominic P. ; Parvataneni, Rupa ; Brener, Sorin J. ; Mehran, Roxana ; Kirtane, Ajay J. ; Stone, Gregg W. / Angiographic predictors of 2-year stent thrombosis in patients receiving drug-eluting stents : Insights from the ADAPT-DES study. In: Catheterization and Cardiovascular Interventions. 2017 ; Vol. 89, No. 1. pp. 26-35.
@article{1b68958821b8493e9b1606bc9acc0fbc,
title = "Angiographic predictors of 2-year stent thrombosis in patients receiving drug-eluting stents: Insights from the ADAPT-DES study",
abstract = "Objectives: We sought to identify angiographic predictors of 2-year stent thrombosis (ST) in the ADAPT-DES study. Background: A strong relationship between platelet reactivity and ST after implantation of drug-eluting stents (DES) was recently confirmed in the prospective, multicenter ADAPT-DES study. Methods: In a pre-specified analysis of patients enrolled in ADAPT-DES, an independent angiographic core laboratory performed detailed angiographic analyses for all cases of ST. Patients with Academic Research Consortium definite/probable target-lesion ST were matched with controls in a 1:2 ratio, and multivariable Cox regression models identified angiographic predictors of 2-year ST. Results: Among 8,582 patients who had successful percutaneous coronary intervention (PCI) and were included in the ADAPT-DES study, 92 (1.1{\%}) patients had ST at 2-year follow-up. Target lesion-related ST was identified in 77 patients (82 lesions) who were clinically matched with 153 patients (196 lesions) without ST. Patients with ST were more likely to have longer target lesions, thrombus, moderate/severe calcification, American College of Cardiology/American Heart Association (ACC/AHA) type C lesions, and saphenous vein grafts. After adjustment for clinical covariates the angiographic variables that predicted ST were lesion complexity (ACC/AHA type C lesion, adjusted HR: 1.97, 95{\%} CI: 1.19 to 3.26, P = 0.01) and presence of thrombus on index PCI (HR: 2.25, 95{\%} CI: 1.40 to 3.59, P < 0.01). Conclusions: Anatomically complex lesions and the presence of thrombus are strong predictors of 2-year ST in the DES era.",
author = "Philippe Genereux and Bj{\"o}rn Redfors and Bernhard Witzenbichler and Akiko Maehara and Mayank Yadav and Giora Weisz and Francese, {Dominic P.} and Rupa Parvataneni and Brener, {Sorin J.} and Roxana Mehran and Kirtane, {Ajay J.} and Stone, {Gregg W.}",
year = "2017",
month = "1",
day = "1",
doi = "10.1002/ccd.26409",
language = "English (US)",
volume = "89",
pages = "26--35",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",
number = "1",

}

Genereux, P, Redfors, B, Witzenbichler, B, Maehara, A, Yadav, M, Weisz, G, Francese, DP, Parvataneni, R, Brener, SJ, Mehran, R, Kirtane, AJ & Stone, GW 2017, 'Angiographic predictors of 2-year stent thrombosis in patients receiving drug-eluting stents: Insights from the ADAPT-DES study', Catheterization and Cardiovascular Interventions, vol. 89, no. 1, pp. 26-35. https://doi.org/10.1002/ccd.26409

Angiographic predictors of 2-year stent thrombosis in patients receiving drug-eluting stents : Insights from the ADAPT-DES study. / Genereux, Philippe; Redfors, Björn; Witzenbichler, Bernhard; Maehara, Akiko; Yadav, Mayank; Weisz, Giora; Francese, Dominic P.; Parvataneni, Rupa; Brener, Sorin J.; Mehran, Roxana; Kirtane, Ajay J.; Stone, Gregg W.

In: Catheterization and Cardiovascular Interventions, Vol. 89, No. 1, 01.01.2017, p. 26-35.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Angiographic predictors of 2-year stent thrombosis in patients receiving drug-eluting stents

T2 - Insights from the ADAPT-DES study

AU - Genereux, Philippe

AU - Redfors, Björn

AU - Witzenbichler, Bernhard

AU - Maehara, Akiko

AU - Yadav, Mayank

AU - Weisz, Giora

AU - Francese, Dominic P.

AU - Parvataneni, Rupa

AU - Brener, Sorin J.

AU - Mehran, Roxana

AU - Kirtane, Ajay J.

AU - Stone, Gregg W.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objectives: We sought to identify angiographic predictors of 2-year stent thrombosis (ST) in the ADAPT-DES study. Background: A strong relationship between platelet reactivity and ST after implantation of drug-eluting stents (DES) was recently confirmed in the prospective, multicenter ADAPT-DES study. Methods: In a pre-specified analysis of patients enrolled in ADAPT-DES, an independent angiographic core laboratory performed detailed angiographic analyses for all cases of ST. Patients with Academic Research Consortium definite/probable target-lesion ST were matched with controls in a 1:2 ratio, and multivariable Cox regression models identified angiographic predictors of 2-year ST. Results: Among 8,582 patients who had successful percutaneous coronary intervention (PCI) and were included in the ADAPT-DES study, 92 (1.1%) patients had ST at 2-year follow-up. Target lesion-related ST was identified in 77 patients (82 lesions) who were clinically matched with 153 patients (196 lesions) without ST. Patients with ST were more likely to have longer target lesions, thrombus, moderate/severe calcification, American College of Cardiology/American Heart Association (ACC/AHA) type C lesions, and saphenous vein grafts. After adjustment for clinical covariates the angiographic variables that predicted ST were lesion complexity (ACC/AHA type C lesion, adjusted HR: 1.97, 95% CI: 1.19 to 3.26, P = 0.01) and presence of thrombus on index PCI (HR: 2.25, 95% CI: 1.40 to 3.59, P < 0.01). Conclusions: Anatomically complex lesions and the presence of thrombus are strong predictors of 2-year ST in the DES era.

AB - Objectives: We sought to identify angiographic predictors of 2-year stent thrombosis (ST) in the ADAPT-DES study. Background: A strong relationship between platelet reactivity and ST after implantation of drug-eluting stents (DES) was recently confirmed in the prospective, multicenter ADAPT-DES study. Methods: In a pre-specified analysis of patients enrolled in ADAPT-DES, an independent angiographic core laboratory performed detailed angiographic analyses for all cases of ST. Patients with Academic Research Consortium definite/probable target-lesion ST were matched with controls in a 1:2 ratio, and multivariable Cox regression models identified angiographic predictors of 2-year ST. Results: Among 8,582 patients who had successful percutaneous coronary intervention (PCI) and were included in the ADAPT-DES study, 92 (1.1%) patients had ST at 2-year follow-up. Target lesion-related ST was identified in 77 patients (82 lesions) who were clinically matched with 153 patients (196 lesions) without ST. Patients with ST were more likely to have longer target lesions, thrombus, moderate/severe calcification, American College of Cardiology/American Heart Association (ACC/AHA) type C lesions, and saphenous vein grafts. After adjustment for clinical covariates the angiographic variables that predicted ST were lesion complexity (ACC/AHA type C lesion, adjusted HR: 1.97, 95% CI: 1.19 to 3.26, P = 0.01) and presence of thrombus on index PCI (HR: 2.25, 95% CI: 1.40 to 3.59, P < 0.01). Conclusions: Anatomically complex lesions and the presence of thrombus are strong predictors of 2-year ST in the DES era.

UR - http://www.scopus.com/inward/record.url?scp=84956652337&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84956652337&partnerID=8YFLogxK

U2 - 10.1002/ccd.26409

DO - 10.1002/ccd.26409

M3 - Article

VL - 89

SP - 26

EP - 35

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 1

ER -