Comparison of Long-Term Outcome After Percutaneous Coronary Intervention for Stent Thrombosis Between Early, Late, and Very Late Stent Thrombosis

Comparison of Short- and Long-Term Cardiac Mortality in Early Versus Late Stent Thrombosis (from Pooled PROTECT Trials)

“…[5][6][7] Some challenges with the accurate ascertainment of clinical event rates in prior studies have included: non-standardized criteria for outcomes; the exclusion of out-of-hospital events; and the lack of endpoint adjudication by an independent events committee. As the data included in our analysis were prospectively collected and adjudicated for the primary trial endpoint of ST and the clinical endpoint of cardiac death, and the PROTECT trial was the first trial designed to include these events beyond one year in the primary endpoint analysis, this secondary analysis of mortality attributable to ST provides a well-characterized population for studying this relationship.…”

“…[1][2][3][4] Alternatively, large registry studies have excluded patients with out-of-hospital events, lacked standardization in the definition and adjudication of ST, and varied in their results. [5][6][7] For instance, data from the CathPCI registry demonstrated that early ST was associated with the highest risk of inpatient mortality, whereas the Registry of Stent Thrombosis for review And Re-evaluation (RESTART) found similar rates of mortality at 30 days and 1 year for patients with early and late ST. 5,6 As the relation between timing of ST and adverse clinical outcomes remains unclear, the present study was conducted to address this question using prospective, pooled patient-level data from PROTECT (Patient Related Outcomes with Endeavor versus Cypher Stenting Trial) and PROTECT Continued Access trials. The PROTECT trials enrolled a broad patient population with both stable angina and acute coronary syndromes in attempt to represent real-world practices, while including protocol-mandated long-term clinical follow-up with central event adjudication for the primary endpoint of ST.…”

A clinical risk score to identify patients at high risk of very late stent thrombosis

“…VLST is a severe complication of percutaneous coronary intervention (PCI) with an annual incidence rate up to 0.7% . Roughly 70% of the patients with VLST present with a myocardial infarction, and the cardiac death rate is up to 10% after 2 years …”

“…[4][5][6] Roughly 70% of the patients with VLST present with a myocardial infarction, and the cardiac death rate is up to 10% after 2 years. 7 The introduction of second generation DES, which are characterized by thinner struts and biocompatible or bio-absorbable polymers, has improved the safety of DES with a significantly lower risk of VLST compared to first generation DES, and a comparable or even lower risk compared to BMS. [8][9][10] Despite the low percentage of patients suffering from VLST nowadays, a large number of patients will still suffer from the consequences of VLST due to the high number of PCI procedures performed worldwide, estimated to be over three million per year.…”

Timing and long-term prognosis of recurrent MI after primary angioplasty

“…In general, ST seems to be associated with worse clinical outcome than MI resultant from native coronary thrombosis [7]. However, in the specific population of patients recovering from a STEMI, it is not clear whether the negative outcome associated with ST is different from that of nonstentrelated recurrent MI (NSRMI) [9,10].…”