Predictors of stent thrombosis after primary stenting for acute myocardial infarction

Abstract

The aim of the study was to determine if a hypercoagulable state that may persist for several months after an acute myocardial infarction may contribute to an increased incidence of stent thrombosis. Primary stenting was performed in 104 consecutive patients with acute myocardial infarction using 147 coronary stents. Twenty‐eight patients (27%) were diabetic and 55 patients (53%) were smokers. A single stent was placed in 63%, two stents in 33%, and more than two stents in 4% of the patients. Procedural success was obtained in 97% of the patients. All stents were deployed using high‐pressure balloon inflation. The reference vessel diameter and minimal lumen diameter after stent deployment were 3.30 ± 0.42 and 3.23 ± 0.42 mm, respectively. Six patients (5.7%) developed stent thrombosis within 1 month after the procedure complicated by reinfarction in five of the six patients. At 1‐month follow‐up, all patients remained alive. On multivariate analysis, independent predictors of stent thrombosis were diabetes mellitus (relative risk [RR] 5.2; 95% confidence interval [CI] 1.8, 25.1), tobacco use (RR 4.5; 95% CI 1.3, 24.5), number of stents: 1 vs. > 1 (RR 3.7; 95% CI 1.1, 15.9), minimal lumen diameter poststent placement (RR 0.03; 95% CI 0.0002, 0.74), and duration of chest pain before intervention (RR 1.1; 95% CI 1.01, 1.25). Stent thrombosis had not been associated with diabetes mellitus and tobacco use previously but is in agreement with the enhanced platelet aggregability, coagulation factor abnormalities, and impaired fibrinolysis characteristic of these patients. Cathet. Cardiovasc. Intervent. 47:415–422, 1999. © 1999 Wiley‐Liss, Inc.

Stent thrombosis following bare-metal stent implantation: success of emergency percutaneous coronary intervention and predictors of adverse outcome

“…5 Â ULN) in 37 (39%) cases. Although the size of myocardial infarction in our study compares favourably with previous reports 29 of infarct size in patients with stent thrombosis, myocardial infarction related to stent thrombosis was associated with a significant decline in left ventricular function. This finding raises concern as left ventricular function has been identified as a strong and consistent predictor of long-term survival following myocardial infarction.…”

Early Coronary Artery Bypass Grafting Following Life-Saving Percutaneous Coronary Intervention

“…Soon, drug-eluting stents have resulted in decreased restenosis rates in treatment of de novo coronary stenosis [8,9]. Diabetes mellitus and smoking were demonstrated as predictors of stent thrombosis [10]. In our study, four out of six diabetic patients had occluded stents, also there were six smokers and they all had occluded stents.…”

Acute coronary syndromes and diabetes mellitus

“…In a cohort of 104 consecutive patients undergoing primary stenting for STEMI, Silva et al demonstrated that the only independent predictors of stent thrombosis were diabetes and tobacco use. 30 This finding may reflect the heightened platelet activation and aggregation among patients with diabetes suffering from an acute STEMI.…”