Incidence and Clinical Features of Early Stent Thrombosis in the Era of New P2y12 Inhibitors (PLATIS-2)

Abstract

Early stent thrombosis (EST) (≤ 30 days after stent implantation) is a relatively rare but deleterious complication of percutaneous coronary intervention (PCI). Administration of newer P2Y12 inhibitors (prasugrel and ticagrelor) combined with aspirin has been shown to reduce the incidence of sub-acute and late stent thrombosis, compared with clopidogrel. We investigated the “real life” incidence of EST in patients from a large acute coronary syndrome (ACS) national registry, where newer P2Y12 inhibitors are widely used. Patients were derived from the ACS Israeli Survey (ACSIS), conducted during 2006, 2008, 2010 and 2013. Major adverse cardiac events (MACE) at 30days were defined as all-cause death, recurrent ACS, EST and stroke.Of the 4717 ACS patients who underwent PCI and stenting, 83% received clopidogrel and 17% newer P2Y12 inhibitors. The rate of EST was similar in both groups (1.7% in the newer P2Y12 inhibitor group vs. 1.4% in the clopidogrel-treated patients, p = 0.42). Results were consistent after multivariate analysis (adjusted HR = 1.06 [p = 0.89]). MACE occurred in 6.4% in the newer P2Y12 inhibitor group compared with 9.2% in the clopidogrel group (P<0.01). However, multivariate logistic regression modeling showed that treatment with newer P2Y12 inhibitors was not significantly associated with the secondary endpoint of MACE when compared with clopidogrel therapy [OR = 1.26 95%CI (0.93–1.73), P = 0.136]. The incidence of "real life" EST at 1month is relatively low, and appears to be similar in patients who receive newer P2Y12 inhibitors as well as in those who receive clopidogrel.

Patients with symptoms and characteristics consistent with obstructive sleep apnea are at a higher risk for acute and subacute stent thrombosis after percutaneous coronary stent implantation: a single-center case–control study

“…We used questionnaires that were answered by both patients and their families to minimize the impact of recall bias on the results of the study. Second, the incidence of stent thrombosis is low [ 1 ], and we only recruited patients with definite stent thrombosis; hence, the study sample was relatively small. Third, this is a single-center study based on clinical data from our hospital database.…”

“…Stent thrombosis is one of the most serious complications of percutaneous coronary intervention (PCI). Even with the use of newer antiplatelet agents, such as P2Y12 receptor inhibitors (e.g., prasugrel and ticagrelor) in combination with aspirin, the incidence of early stent thrombosis (EST) after PCI has been reported to be 1.4%–1.7% [ 1 ]. Although this incidence seems relatively low, EST is a life-threatening complication, as it often leads to acute myocardial infarction or sudden death, and is associated with a mortality rate of up to 45% [ 2 ].…”

Trends in long-term prognosis according to left ventricular ejection fraction after acute coronary syndrome

“…The present study is a cohort data analysis of patients who were enrolled prospectively in the Acute Coronary Syndrome Israeli Survey (ACSIS) from 2000 to 2016. Details of the ACSIS have been previously reported [12]. In brief, the ACSIS database is a prospective bi-annual evaluation of patients hospitalized with ACS in cardiology departments and intensive coronary care units in 26 medical centers operating in Israel, for a two-month period.…”

Temporal Trends in Prognosis of Patients with Acute Coronary Syndrome Complicated by Ventricular Tachyarrhythmia

“…The present study is a cohort data analysis of patients who were enrolled prospectively in the ACSIS from 2000 to 2016. Details of ACSIS have been previously reported (6). In brief, this survey is conducted biennially over a 2-month period among ACS patients admitted to coronary care units and cardiology wards in all 27 public hospitals in Israel.…”