ステント血栓症再発の予測

オランダのステント血栓症スタディの結果、ステント血栓症は一般的に認められ、治療のために新たなステントを留置することによりさらなる血栓症再発のリスクを増加させることが明らかになった
Dutch Stent Thrombosis Study finds that stent thrombosis is common and that placement of a new stent during repair increases risk for further recurrence
ステント血栓症は比較的一般的に認められ、他のステントを留置するなどの治療はさらなる血栓症のリスクを増加させるとのLate-Breaking Clinical Trialの結果がAmerican College of Cardiology学会で発表された。オランダステント血栓症スタディでは初めてステント血栓症を造影上確認された連続する患者437人を組み入れた。フォローアップ中に74人（16.9%）がステント血栓症を再発した。このグループのうち61人は2回、12人は3回、そして1人は4回ステント血栓を発症した。ステント血栓症再発の3つの予測因子が明らかにされた。初回エピソードに対する緊急治療中の新たなステント留置により再発リスクは4.2倍増加し、心筋梗塞の既往によりリスクは2.6倍、後期血栓によりリスクは2.1倍上昇した。
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Stent thrombosis is relatively common, and treatment that includes placement of another stent increases the risk for further thrombosis, according to a late-breaking clinical trial presented at the meeting of the American College of Cardiology.

Jochem Wouter van Werkum, MD, a cardiologist at St Antonius Hospital, Nieuwegein, the Netherlands, led the Dutch Stent Thrombosis Study. He and his colleagues enrolled a total of 437 consecutive patients who had stent thrombosis confirmed by angiography between January 2004 and February 2007.

The researchers collected data on clinical characteristics (for example, diabetes, age and duration of antiplatelet therapy), angiographic characteristics (for example, undersizing of the stent, dissection and whether the lesion was located at an arterial branchpoint), and procedural characteristics (for example, whether a drug-eluting or bare-metal stent was used and the length and diameter of the stent).

The researchers found that 74 of the 437 patients (16.9 percent) experienced multiple episodes of stent thrombosis. Of these, 61 patients had two episodes of stent thrombosis, 12 patients had three episodes and one patient had four episodes.

Further analysis revealed three independent predictors of repeat stent thrombosis. Patients who had an additional stent implanted during emergency treatment for the first episode of stent thrombosis were 4.2 times as likely as other patients to experience a repeat
episode of stent thrombosis. Patients with a previous myocardial infarction faced 2.6 times the usual risk of repeat stent thrombosis, and patients who developed thrombosis long after stent implantation (late stent thrombosis) faced 2.1 times the usual risk of a repeat episode.

Dr. van Werkum and his colleagues concluded that additional stent placement at the time of emergency treatment for the first stent thrombosis should be avoided.