Journal of Invasive Cardiology

Stent thrombosis represents an infrequent but potentially grave complication of percutaneous coronary intervention (PCI). With current antithrombotic regimens, stent thrombosis occurs after fewer than 1% of stent-based interventions,1,2 but may be more frequent in acute coronary syndromes,3,4 multivessel procedures,5 and other high-risk circumstances where rates have approached 3% or more. The clinical manifestations of stent thrombosis are well recognized and include death rates of 20–25% and major myocardial infarction in 60–70%.2,6,7 However, the economic impact of these events is unknown. Therefore, we reviewed a series of cases of subacute thrombosis (SAT) at our institution in order to estimate the magnitude of health care costs generated.

Methods

Study population. We searched the interventional cardiology database at our institution and identified 32 cases of angiographically documented stent thrombosis out of a total of 3,295 stent procedures, between the years 1998 to 2000. Qualifying events were required to occur after the completion of the initial PCI. For 26 of the 32 cases, complete clinical records and billing data were available; these 26 cases comprise the study population. The study protocol was approved by the Committee on Clinical Investigations of Beth Israel Deaconess Medical Center.

Clinical data. For all patients, baseline demographic and health history data were obtained by review of the medical record. Detailed procedural data for both the index revascularization procedures and for subsequent procedures performed to manage SAT were collected from catheterization laboratory reports. Clinical outcomes were determined from chart review and discharge summaries.