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).
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