Predictors and implications of stent thrombosis in non-ST-segment elevation acute coronary syndromes: the ACUITY Trial

Circ Cardiovasc Interv. 2011 Dec 1;4(6):577-84. doi: 10.1161/CIRCINTERVENTIONS.111.963884. Epub 2011 Oct 25.


Background: The frequency, predictors, and consequences of stent thrombosis (ST) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) have been incompletely studied. We sought to investigate the incidence, predictors, and clinical implications of ST occurring within 1 year after percutaneous coronary intervention in patients with NSTE-ACS.

Methods and results: The Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial was a large-scale, prospective, randomized trial of antithrombotic regimens in patients with NSTE-ACS. The present analysis includes 7162 patients in whom stents were implanted. At 1 year, definite/probable ST occurred in 146 patients (2.2%), including 94 definite and 52 probable events. There were 100 episodes (1.4%) of early ST (within the first 30 days) and 46 episodes (0.8%) of late ST (between 30 days and 1 year). The incidence of ST within 1 year was similar in patients treated with drug-eluting stents or bare metal stents (hazard ratio, 0.86; 95% confidence interval, 0.62-1.20; P=0.38) and was independent of procedural antithrombotic treatment. Patients with ST compared with those without ST had strikingly higher 1-year rates of cardiac mortality (32.4% versus 2.9%, P<0.0001), myocardial infarction (82.6% versus 7.6%, P<0.0001), and target vessel revascularization (79.6% versus 7.4%, P<0.0001). Independent predictors of 1-year definite/probable ST were insulin-treated diabetes mellitus, number of diseased vessels, and ST-segment deviation ≥1 mm.

Conclusions: Compared with elective stent implantation, ST occurs with increased frequency in the first year after stent implantation in patients with NSTE-ACS, especially within the first 30 days, and is associated with marked increases in cardiac mortality and adverse events. Insulin-treated diabetes, number of diseased vessels, and dynamic ST-segment changes were independent predictors of 1-year ST in NSTE-ACS.

Trial registration: NCT00093158.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / pathology
  • Acute Coronary Syndrome / therapy*
  • Aged
  • Angioplasty, Balloon, Coronary*
  • Comorbidity
  • Coronary Thrombosis / epidemiology*
  • Coronary Thrombosis / prevention & control
  • Coronary Vessels / pathology
  • Diabetes Mellitus, Type 1 / epidemiology
  • Drug-Eluting Stents / adverse effects*
  • Electrocardiography
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Follow-Up Studies
  • Humans
  • Male
  • Metals*
  • Middle Aged
  • Predictive Value of Tests
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Stents / adverse effects*


  • Fibrinolytic Agents
  • Metals

Associated data