Stent thrombosis incidence in bare metal stents
Coronary stent thrombosis Microchapters
Epidemiology and Demographics
Stent thrombosis incidence in bare metal stents On the Web
Multiple contemporary studies involving single center and multi center experience suggests an overall lifetime incidence of stent thrombosis is 0.5 % - 2.5 %.    There is some variation of these numbers with the definitions used. For instance, in a recent study of 8847 patients who received a BMS, a cumulative incidence of definite, probable or possible stent thrombosis (ST) over 15 months was 2.15% and that for definite ST was 0.61%. In a study involving serial angiography after sirolimus-eluting stent (SES) and BMS implantation at 4, 11, and 21.2 ± 2.2 months, no BMS developed thrombus, however SES demonstrated the presence of thrombi and yellow plaques even as much as 2 years after implantation.
Incidence in Bare Metal Stents
Incidence of Early ST in BMS
For purposes of discussion this group would include:
- Intra-procedural ST
- Acute ST: up to 24 hrs
- Subacute ST: 24 hrs to 30 days
Supportive Trial Data
- In study of 7484 patients with (intra vascular ultrasound study) IVUS before and after stenting, incidence of ST was 0.4% up to a week. The median time of ST was 24 hours and the minimum time was 1 hour.
- In a retrospective analysis 4509 patients the rate of subacute ST was 0.51%.
Higher Incidence of Subacute ST in Special Patient Populations
- In a group of 40 patients who underwent non cardiac surgery following BMS, the incidence of ST while on two antiplatelet agents appeared to be 2.5 % (one patient out of 40).
- Incidence of ST in patients with acute coronary syndrome(ACS) are higher than those with stable angina as demonstrated by ACUITY and TRITON-TIMI 38 trial databases. 
- The incident rates of early ST in ACS i.e STEMI and NSTEMI have shown to be 1.4 - 1.6%, and 0 - 2.9% respectively while ST incidence in patients with stable angina is 0 - 0.5%.
Incidence of ST from 30 days up to 3 years or longer
This would include:
- Late ST: 30 days to one year
- Very late ST: more than one year, but generally less than 3 years
- Later than 3 years
The reported incidence in this group ranges between 0-0.5%. Given the paucity of data only assumptions can be made for the group beyond 1-3 years.
Incidence of Late-ST
- The incidence of late ST with BMS was 0.28% in a meta-analysis of 14 trials looking at 6675 patients.
- Long term aspirin therapy is necessary to reduce the incidence of late ST in patients with BMS. 
- With the use of second generation BMS, and current antithrombotic regimens (aspirin and thienopyridine) the 30 days ST incidence range from 0.5-2.5% in high risk patients.  The incidence is higher if aspirin is used alone or when warfarin is used along with aspirin without thienopyridine.
Incidence of Very Late-ST
- It appears that ST in the very late group is exceedingly rare.
- In a meta-analysis of 14 trials looking at 6675 patients no patient presented with very late ST of BMS. However regular follow up of most patients confined to one year or less.
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