Editorial
Early stent thrombosis. Aetiology, treatment, and prognosis

Stent thrombosis (ST) is an uncommon but life-threatening complication after percutaneous coronary intervention (PCI), frequently manifesting as acute coronary syndrome (ACS) or even cardiac death.
According to the academic research consortium (ARC), the definition includes definite, probable, or possible ST and is described in detail elsewhere [1].
Traditional classification categorises this complication into early (including acute and subacute ST, within 24 h and from 24 h to 30 days, respectively), late (from 30 days to 1 year), and very late (after 1 year). However, this classification does not include intraprocedural coronary thrombosis, which occurs in nearly 1% of patients [2] and is more common in the setting of ACS [3].
The majority of these events seem to occur within the first month after PCI. Among 21,009 patients treated with bare metal stents or drug eluting stents (DES) from the Dutch Stent Thrombosis Registry, 437 patients experienced ST and only 27% occurred late or very late [4]. Similar results were observed with bioresorbable vessel scaffolding (BVS) within large multicentre GOUST-EU registry (1189 patients included), where ST mostly clustered within 30 days [5]. A shift toward later ST occurrence was observed within the Japanese ST RESTART registry. This included patients treated with sirolimus eluting stents and comprised 611 patients with definite ST. Among them 47% occurred after 1 year [6]. The higher rate of late and very late ST in the Japanese registry may be associated with prolonged healing of the vessel after implantation of DES with potent antiproliferative sirolimus drug.
Finally, a completely different pattern of ST timing was observed within the impressive number of 401,662 ACS patients from the CathPCI registry [7]. Among them, definite ST events were identified in 7315. Very late ST constituted as much as 61%, and only 19% of patients presented as early ST.
The broad spectrum of risk factor categories is related to the patient (incl. clinical presentation), lesion, stent, and antiplatelet therapy (Table I). Among them, premature cessation of dual antiplatelet therapy (DAPT) seems to be the strongest single risk factor for ST. However, this seems only partially true for early ST, as the majority of patients experiencing ST within the first month remain on DAPT (88% in the Dutch ST Registry) [4]. Furthermore, as shown in the ST-elevation myocardial infarction (STEMI) patient population from...


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