Stent thrombosis (ST) is a serious complication of coronary PCI. However, its incidence across registries is low. It has been classified according to onset into acute (less than 24 hrs.), subacute (between 24 and 30 days), late (between 30 and 365 days) and very late (later than 365 days). The estimated incidence of ST is 1% within the first year. The most common clinical presentation of ST is through ST elevation acute coronary syndrome (ST-ACS).
The aim of this study was to examine the incidence, characteristics and hospital outcomes of patients undergoing coronary PCI for ST compared against patients without ST undergoing PCI.
It was a retrospective study of ACS patients from England and Wales from the British Cardiovascular Intervention Society (BCIS) percutaneous coronary intervention registry, who were stratified into ST and non-ST. Primary end points were in-hospital major cardio and cerebrovascular events (MACCE), all-cause mortality and BARC 3-5 bleeding.
Of a total 571,949 procedures, 61.5% were for SCA and 2.3% for ST (1.4% of the total cohort); 52.6% were early ST, 12% late ST and 35.4% very late ST.
Patients with ST treatment indication were generally younger (64.6 – 64.9 vs 65.4 years), mostly men (81.2% vs 73%) and the most frequent presentation was ST-ACS (74.7% vs 40%).
ST intervention was associated to more use of mechanical ventilation (6% vs 3.1%) or circulatory support (6.1% vs 2.4%). The use of IVUS/OCT was more frequent in this clinical scenario vs. patients without ST (30.5% vs 8.4%). As regards device, patients with ST less frequently received drug eluting stents (66.9% vs 84.6%), mainly at the expense of a higher use of drug coated balloons (1.8% vs 0.2%). There was also more frequent use of more potent antiaggregants (Prasugrel and Ticagrelor).
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In ST patients undergoing PCI, there were more MACCE (6.4% vs 3.5%), especially among the early ST patients (8.1%). This difference was noted at the expense of higher all-cause mortality (5.7% vs 3.0%). When looking at time ranges, the rate of PCI for ST declined, comparing years 2014-2015 against 2019-2020.
After adjusting for baseline differences, the difference in MACCE was higher in ST patients (OR 1.22, IC 95% 1.05vs1.41) and all-cause mortality (OR 1.21, IC 95% 1.07-1.36). At multivariable analysis, the strongest predictors were ST ACS (OR: 3.07), renal failure (OR: 3.49) and ventricular function deterioration (OR:3.98).
Conclusions
This important cohort of patients spanning 7 years is one of the largest on stent thrombosis, with 1.4% incidence of all PCI procedures, a rate that has been falling lately. In addition, intravascular imaging examinations such as IVUS/OCT were underused as complementary techniques to look into the cause of ST.
Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.
Reference: Mohamed, Mohamed O et al. “Temporal patterns, characteristics, and predictors of clinical outcomes in patients undergoing percutaneous coronary intervention for stent thrombosis.” EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology vol. 18,9 (2022): 729-739. doi:10.4244/EIJ-D-22-00049.
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