Incidence, predictors, and clinical outcomes of early stent thrombosis in acute myocardial infarction patients treated with primary percutaneous coronary angioplasty (insights from the University of Ottawa Heart Institute STEMI registry)

Abstract

The incidence of early ST in primary PCI cohort is low. However, it is still associated with higher mortality and morbidity. Small stent diameter and disuse of intracoronary glycoprotein IIb/IIIa inhibitor may be associated with early ST.

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

“…We also found no difference in the rates of cardiogenic shock, intra‐aortic balloon pump, and inotropes utilization between the two groups. This finding is in contrast to other studies that reported higher rates of hemodynamic compromise presentations with ST compared to de novo lesions which would underestimate the adverse prognosis of ST recorded by hospital‐based registries.…”

“…5 The use of PCI techniques such as high-pressure stent implantation, high-pressure post-dilation, intravascular imaging to achieve optimal stent expansion and apposition, and dual antiplatelet therapy in conjunction with improved stent profiles is thought to reduce the frequency of ST in the modern era. 6 Data on the outcomes of STEMI secondary to ST as compared to those due to a de novo lesion remain sparse with relatively small numbers, 7 which limit the assessment of this group of patients. Additionally, the reported high mortality associated with ST appears to be predominantly driven by in-hospital outcomes with very few studies assessing the impact on survival following discharge from hospital.…”

Effects of Intracoronary Pro-urokinase or Tirofiban on Coronary Flow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Multi-Center, Placebo-Controlled, Single-Blind, Randomized Clinical Trial

“…Randomized clinical trials have suggested that intracoronary administration of tirofiban to achieve a high local concentration of the drug can reverse no-flow phenomena and attenuate microvascular obstruction in patients with STEMI undergoing primary PCI (19,(35)(36)(37). Our finding that myocardial reperfusion is improved by intracoronary infusion of tirofiban during primary PCI for acute STEMI is consistent with the above studies and with numerous other investigations evaluating the effects of intracoronary administration of glycoprotein IIb/IIIa inhibitors during PCI (14)(15)(16)(17)(18)(19).…”

“…Glycoprotein IIb/IIIa inhibitors such as tirofiban prevent platelet aggregation and have been administered intravenously to reduce periprocedural ischemic events in patients undergoing PCI (13). Notably, studies during the last decade have suggested that intracoronary administration of a glycoprotein IIb/IIIa inhibitor during primary PCI can improve myocardial reperfusion and clinical outcomes in patients with STEMI (14)(15)(16)(17)(18)(19).…”

Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients

“…In one large observational study it was reported that the incidence of stent thrombosis in OHCA patients undergoing PCI was 4.7% 136 . In comparison, myocardial-infarction patients without cardiac arrest and receiving a stent have a reported incidence of stent thrombosis of 0.5-1.0% 137,138 .…”