In the ACUITY trial of over 3400 patients with ACS who underwent stent implantation, the 30 day rate of stent thrombosis was 1.4% (no different with bare metal or drug-eluting stents). The most significant co-morbid factors associated with early stent thrombosis were insulin requiring diabetes, renal insufficiency, and overall burden of atherosclerosis. Lack of pre-procedural, or inconsistent 30 day use of a thienopyridine (such as clopidogrel) was also, not surprisingly, a strong predictor. Although all patients should be counseled as to the importance of post-stent thienopyridine use, the message has to be loud and clear in those with renal insufficiency, diabetes, and high atherosclerotic burden (abstract).
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.