|
|
| Line 1: |
Line 1: |
| {{SI}}
| |
|
| |
|
| {{CMG}}
| |
|
| |
| {{Editor Help}}
| |
|
| |
| [[Coronary stent thrombosis]] (ST) is the sudden occlusion of a stented coronary artery due to formation of thrombosis. The clinical consequences of ST are frequently catastrophic and include death in 20-48% or major [[myocardial infarction]] ([[MI]]) in 60-70% of the cases.<ref name="pmid8598866">{{cite journal| author=Schömig A, Neumann FJ, Kastrati A, Schühlen H, Blasini R, Hadamitzky M et al.| title=A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 17 | pages= 1084-9 | pmid=8598866 | doi=10.1056/NEJM199604253341702 | pmc= | url= }} </ref><ref name="pmid8996288">{{cite journal| author=Moussa I, Di Mario C, Reimers B, Akiyama T, Tobis J, Colombo A| title=Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome. | journal=J Am Coll Cardiol | year= 1997 | volume= 29 | issue= 1 | pages= 6-12 | pmid=8996288 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8996288 }} </ref><ref name="pmid15029110">{{cite journal| author=Kereiakes DJ, Choo JK, Young JJ, Broderick TM| title=Thrombosis and drug-eluting stents: a critical appraisal. | journal=Rev Cardiovasc Med | year= 2004 | volume= 5 | issue= 1 | pages= 9-15 | pmid=15029110 | doi= | pmc= | url= }} </ref>
| |
|
| |
| ==Issues with interpreting data==
| |
| Some clinical trials excluded patients who underwent repeat target vessel revascularization. Given that this is more likely to be on a [[bear metal stent]] ([[BMS]]), there might have been room for bias. In some studies definition of late ST may have underestimated the true incidence of ST due to the exclusion of unexplained [[myocardial infarction]] ([[MI]])s in the territory of the stented vessels and late deaths, which may have been due to stent thromboses.
| |
| In some trials the patient who presented for revascularization of [[BMS]] patients were exluded which may have biased the interpretation of the results.
| |
|
| |
| To resolve this issue and standardize the diagnosis, Academic Research Consortium(ARC) came up with the definitions of stent thrombosis<ref name="pmid17470709">{{cite journal |author=Cutlip DE, Windecker S, Mehran R, ''et al.'' |title=Clinical end points in coronary stent trials: a case for standardized definitions |journal=Circulation |volume=115 |issue=17 |pages=2344–51 |year=2007 |month=May |pmid=17470709 |doi=10.1161/CIRCULATIONAHA.106.685313 |url=}}</ref> which will be discussed in this section.
| |
|
| |
| ==Definition based on timing of stent thrombosis (ST)==
| |
| *'''Acute stent thrombosis:''' 0 to 24 hrs after stent implantation
| |
| *'''Subacute stent thrombosis:''' > 24 hours to 30 days after stent implantation
| |
| *'''Late stent thrombosis:''' >30 days to 1 year after stent implantation
| |
| *'''Very late stent thrombosis:''' >1 year after stent implantation
| |
|
| |
| ==Definition based on certainty of ST==
| |
| ===Definite Stent Thombosis===
| |
| '''1)''' Angiographic confirmation of stent thrombosis: The presence of intracoronary thrombus that originates in the stent or in the segment '''5 mm proximal or distal to the stent''' and presence of at least 1 of the following criteria within a 48-hour time window:
| |
| *Acute onset of ischemic symptoms at rest
| |
| *New ischemic [[ECG]] changes that suggest acute ischemia
| |
| *Typical rise and fall in [[cardiac biomarkers]]
| |
| *Nonocclusive [[thrombus]]-Intracoronary thrombus is defined as a (spheric, ovoid, or irregular) noncalcified filling defect or lucency surrounded by contrast material (on 3 sides or within a coronary stenosis) seen in multiple projections, or persistence of contrast material within the lumen, or a visible embolization of intraluminal material downstream.
| |
| *Occlusive thrombus-TIMI 0 or TIMI 1 intrastent or proximal to a stent up to the most adjacent proximal side branch or main branch (if originates from the side branch).
| |
|
| |
| '''2)''' Pathological confirmation of stent thrombosis: Evidence of recent thrombus within the stent determined at autopsy or via examination of tissue retrieved following [[thrombectomy]].
| |
|
| |
| ===Probable Stent Thrombosis===
| |
| Clinical definition of probable stent thrombosis is considered to have occurred after intracoronary stenting in the following cases:
| |
| *Any unexplained death within the first 30 days
| |
| *Irrespective of the time after the index procedure, any [[MI]] that is related to documented acute [[ischemia]] in the territory of the implanted stent without angiographic confirmation of stent [[thrombosis]] and in the absence of any other obvious cause.
| |
|
| |
| ===Possible Stent Thrombosis===
| |
| Clinical definition of possible stent thrombosis is considered to have occurred with any unexplained death from 30 days after intracoronary stenting until end of trial follow-up.
| |
|
| |
| It should be noted that the incidental angiographic documentation of stent occlusion in the absence of clinical signs or symptoms is not considered a confirmed stent thrombosis (silent occlusion).
| |
|
| |
| ==References==
| |
| {{reflist}}
| |
|
| |
| {{SIB}}
| |
| [[Category:Cardiology]]
| |
|
| |
| {{WikiDoc Help Menu}}
| |
| {{WikiDoc Sources}}
| |