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Simple risk score predicted stent thrombosis
Stent thrombosis can be predicted using a simple risk score based on 10 clinical, angiographic and procedural variables, according to study results published in the Journal of American College of Cardiology: Cardiovascular Interventions.
George D. Dangas, MD, PhD, and fellow researchers created a patient-level pooled analysis of 6,139 patients undergoing PCI for ACS from the HORIZONS-AMI and ACUITY trials. Patients were randomly assigned to treatment with bivalirudin (Angiomax, The Medicines Company) vs. heparin plus a glycoprotein IIb/IIIa inhibitor. The cohort was randomly divided into either a risk score development cohort (n=4,093) or a validation cohort (n=2,046). Characteristics associated with Academic Research Consortium-defined definite/probable stent thrombosis at 1 year were assigned an integer score based on the regression coefficients.
The 10 variables were: type of ACS; current smoking; insulin-dependent diabetes; prior PCI; baseline platelet count; absence of pre-PCI anticoagulant therapy; aneurysmal/ulcerated lesion; baseline TIMI flow grade of 0/1; final TIMI flow grade <3; and number of treated vessels. Low risk was defined as a score of 1 to 6; intermediate risk, 7 to 9; and high risk, ≥10.
In the development cohort, rates of stent thrombosis were 1.36% in low-risk, 3.06% in intermediate-risk and 9.18% in high-risk patients (P for trend <.001). In the validation cohort, rates of stent thrombosis were 1.65% in low-risk, 2.77% in intermediate-risk and 6.45% in high-risk patients (P for trend =.006).
George D. Dangas
“We believe that the development and initial validation of this stent thrombosis risk score can be a useful tool for both clinical practice and future clinical investigation (future analyses of trials or registries), as it can be a simple way to risk stratify patients immediately following a procedure,” Dangas and colleagues wrote. “The risk score could also be used in the informed-consent process to better inform patients of their individual risk of stent thrombosis.”
Disclosure: Dangas has received speaker honoraria from Abbott Vascular, AstraZeneca, Bristol-Myers Squibb, Sanofi-Aventis and The Medicines Company.