Incidence, Predictors, and Implications of Reinfarction After Primary Percutaneous Coronary Intervention in ST-Segment–Elevation Myocardial Infarction

Abstract

Background-Reinfarction after primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction has negative consequences. Little is known about reinfarction after drug-eluting stents and bivalirudin anticoagulation. We, therefore, sought to determine the incidence, predictors, and implications of reinfarction after primary percutaneous coronary intervention in the contemporary era. Methods and Results-Outcomes were assessed in 3202 patients undergoing stent implantation for ST-segment-elevation myocardial infarction in the Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. Independent predictors of reinfarction and mortality were identified by Cox proportional hazards modeling. The cumulative incidence of reinfarction was 1.8% at 30 days, 4.0% at 1 year, and 6.9% at 3 years. Definite stent thrombosis was responsible for 76.3% of reinfarctions occurring within 30 days and 52.0% of all reinfarctions within 3 years. Independent predictors of reinfarction were current smoking, Killip class ≥2, baseline thrombocytosis, multivessel disease, symptom onset-to-balloon time, and total stent length. Randomization to bivalirudin versus heparin plus a glycoprotein IIb/ IIIa inhibitor and use of drug-eluting versus bare metal stents were not significant predictors of reinfarction. Reinfarction was a powerful independent predictor of subsequent cardiac mortality (hazard ratio

Prevalence and predictors of high-on treatment platelet reactivity with ticagrelor in ACS patients undergoing stent implantation

“…In fact, the occurrence of stent thrombosis still remains relatively high, due to the larger and larger complexity of current ACS patients, with negative impact of survival [31][32][33].…”

Double‐Dose Versus Standard‐Dose Clopidogrel According to Smoking Status Among Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

“…However, recent studies have highlighted the detrimental influence of smoking on short-and longterm outcome in ACS patients, with a substantially higher risk for re-infarction, stent thrombosis, and death in smokers, irrespective of age. [7][8][9][10][11][12][13] ADP receptor blockers, including clopidogrel, reduce the risk for repeat MI, stroke, and cardiovascular death in patients with an ACS. [14][15][16] They also reduce the risk for stent thrombosis after percutaneous coronary interventions (PCI) and stenting.…”

A szívinfarktusért felelős ér prognosztikus jelentőségének vizsgálata ST-elevációs szívinfarktusos betegekben

“…A CV gyakoriságát vizsgálva azt találtuk, hogy a LAD volt a leggyakoribb CV, amit RCA és LCx követett. Ezzel megegyező gyakoriságot közöltek több közleményben [9][10][11][12]. Adataink a CV prognosztikus jelentőségét igazolták: az LM-betegcsoportban találtuk a legrosszabb prognózist, ezt a LAD-csoportba tartozó betegek követték.…”