Clinical outcomes following ST‐elevation myocardial infarction secondary to stent thrombosis treated by percutaneous coronary intervention

Abstract

Objectives: To assess the clinical outcomes of patients presenting with ST-elevation myocardial infarction (STEMI) secondary to stent thrombosis (ST) compared to those presenting with STEMI secondary to a de novo culprit lesion and treated by percutaneous coronary intervention (PCI). Background: ST is an infrequent but serious complication of PCI with substantial associated morbidity and mortality, however with limited data. Methods: We studied consecutive patients who underwent PCI for STEMI from 2005 to 2013 enrolled prospectively in the Melbourne Interventional Group registry. Patients were divided into two groups: the ST group comprised patients where the STEMI was due to ST and the de novo group formed the remainder of the STEMI cohort and all patients were treated by PCI. The primary endpoint was 30-day allcause mortality. The MIG Steering Committee and the investigators, data managers, and institutions participated in the MIG Database are listed in Appendix.

Short- and long-term prognosis of primary PCI in nonacute stent thrombosis STEMI

“…Our study found that compared with STEMI patients with de novo lesions, patients with nonacute stent thrombosis had more coronary heart disease risk factors and were more likely to have hypertension and hyperlipidemia. At the same time, a higher proportion of patients with nonacute stent thrombosis had a prior cardiovascular history, including prior CABG treatment (9). Our study also found that the nonacute stent thrombosis group had a higher rate of heart failure and a lower left ventricular EF at admission.…”

“…Mortality was 4 times higher in patients with late stent thrombosis than in patients without stent-related MI at the 5-year follow-up (7). Noaman et al (9) analyzed data from the Melbourne Interventional Group Registry from 2005 to 2013 and found that there were no signi cant differences in the short-term outcomes of in-hospital and 30-day mortality or in-hospital and 30-day MACE events between STEMI patients with stent-induced thrombosis and STEMI patients with de novo lesions. Multivariate analysis showed that stent thrombosis was not an independent risk factor for 30-day death or 30-day MACEs in STEMI patients (9).…”

“…Noaman et al (9) analyzed data from the Melbourne Interventional Group Registry from 2005 to 2013 and found that there were no signi cant differences in the short-term outcomes of in-hospital and 30-day mortality or in-hospital and 30-day MACE events between STEMI patients with stent-induced thrombosis and STEMI patients with de novo lesions. Multivariate analysis showed that stent thrombosis was not an independent risk factor for 30-day death or 30-day MACEs in STEMI patients (9). Chechi et al (8) reported a higher incidence of in-hospital MACEs in STEMI patients with stent-induced thrombosis, but no signi cant difference was found in new MACEs in patients with de novo lesions at the 6-month follow-up.…”

“…These nonacute stent thrombosis patients can clinically present with acute myocardial infarction, unstable angina pectoris, etc. ST-segment elevation myocardial infarction (STEMI) is the most common presentation, with an incidence of 59-80% (7,8), accounting for 3.2% of all STEMI patients (9). Percutaneous coronary intervention (PCI) is also an effective treatment for patients with nonacute stent thrombosis (10), but the clinical prognosis is still not very clear.…”

The outcome of primary percutaneous coronary intervention in patients with stent thrombosis

“… 22 This study further reported that manual thrombus aspiration is not associated with improved reperfusion or long-term outcomes in contemporary PCI setting for ST patients. 22 Similarly, Noaman S et al 23 also reported very late ST in 64% of the cases. Compared to de novo STEMI, patients with STEMI due to ST were found to have a higher prevalence of dyslipidemia, hypertension, and diabetes mellitus, and outcomes after primary PCI in patients with STEMI due to ST were comparable to the outcomes of de novo STEMI.…”