Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients

Abstract

Objective We sought to determine the incidence, angiographic predictors, and impact of stent thrombosis (ST). Background Given the high mortality after ST, this study emphasises the importance of ongoing efforts to identify angiographic predictors of ST. Methods All consecutive patients with angiographically confirmed ST between 2010 and 2016 were 1:4 matched for (1) percutaneous coronary intervention (PCI) indication and (2) index date ±6 weeks to randomly selected controls. Index PCI angiograms were reassessed by two independent cardiologists. A multivariable conditional logistic regression model was built to identify independent predictors of ST. Results Of 6,545 consecutive patients undergoing PCI, 55 patients [0.84%, 95% confidence interval (CI) 0.63–1.10%] presented with definite ST. Multivariable logistic regression identified dual antiplatelet therapy (DAPT) non-use as the strongest predictor of ST (odds ratio (OR) 10.9, 95% CI 2.47–48.5, p < 0.001), followed by: stent underexpansion (OR 5.70, 95% CI 2.39–13.6, p < 0.001), lesion complexity B2/C (OR 4.32, 95% CI 1.43–13.1, p = 0.010), uncovered edge dissection (OR 4.16, 95% CI 1.47–11.8, p = 0.007), diabetes mellitus (OR 3.23, 95% CI 1.25–8.36, p = 0.016), and residual coronary artery disease at the stent edge (OR 3.02, 95% CI 1.02–8.92, p = 0.045). ST was associated with increased rates of mortality as analysed by Kaplan-Meier estimates (27.3 vs 11.3%, p log-rank < 0.001) and adjusted Cox proportional-hazard regression (hazard ratio 2.29, 95% CI 1.03–5.10, p = 0.042). Conclusions ST remains a serious complication following PCI with a high rate of mortality. DAPT non-use was associated with the highest risk of ST, followed by various angiographic parameters and high lesion complexity. Electronic supplementary material The online version of this article (10.1007/s12471-019-1253-2) contains supplementary material, which is available to authorized users.

Dual anti-thrombotic treatment with direct anticoagulants improves clinical outcomes in patients with Atrial Fibrillation with ACS or undergoing PCI. A systematic review and meta-analysis

“…On the contrary, we maintained the same between-the-groups comparison across all included studies and could not find any significant difference in Stent Thrombosis rate among. Nevertheless, it should be remembered that the risk for Stent Thrombosis has a large interindividual variability, being influenced both by patient-related factors such as diabetes, chronic kidney disease and prior stent thrombosis, and by lesion-specific factors, such as location, number and length of treated lesions, lesion anatomy and procedural factors, like stent under-expansion, geographic miss and iatrogenic dissection [ 14 ]. Stent thrombosis rate was highest among patients receiving DAPT for only 1 month in the PIONEER AF-PCI.…”

“…Thrombosis has a large interindividual variability, being influenced both by patient-related factors such as diabetes, chronic kidney disease and prior stent thrombosis, and by lesion-specific factors, such as location, number and length of treated lesions, lesion anatomy and procedural factors, like stent under-expansion, geographic miss and iatrogenic dissection [14]. Stent thrombosis rate was highest among patients receiving DAPT for only 1 month in the PIO-NEER AF-PCI.…”

Management of acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura, the value of optical coherence tomography: a case report

“…However, it is well known that thrombocytopenia does not give immunity against such conditions. 4 There have been several case reports of patients with thrombocytopenia associated with various illnesses such as cancers, hereditary thrombocytopenias, ITP, etc. who also got ACS.…”

“…As regards to percutaneous coronary intervention, a difficult decision needs to be made as whether to put a stent or not as in-stent thrombosis has mortality of 17-45%. 4 Here we present a patient with difficult-to-treat ITP presenting with acute coronary syndromes (ACS) and discuss management options, highlighting the benefit of using optical coherence tomography (OCT).…”

The Role of Novel Oral Anticoagulants and Antiplatelet Therapy after Percutaneous Coronary Intervention: Individualizing Therapy to Optimize Outcomes

“…While in 1 analysis of 6 randomized controlled trials, reference vessel diameter was the only predictor of target lesion failure, there are several other high-risk lesion-related features which have been associated with worse clinical outcomes 21). Stent underexpansion, edge dissection and residual reference segment disease play a significant role in the occurrence of future ischemic events including stent thrombosis 22). Identification of these risk factors is essential to appropriately tailor the optimal duration of DAPT.…”