Author + information
- Shazia Hussaina,b,
- Ashish Shaha,b,
- Annam Muthuppalaniappana,b,
- Nazar Mohammeda,b,
- Sanjit Jollya,b,
- Christopher Overgaarda,b and
- Vladimir Dzavika,b
Background: Stent thrombosis (ST) is associated with an in hospital mortality of up to 10% and a 30-day mortality of 10-25%, rates that are based predominantly on registry data. We sought to assess the outcome of a cohort of patients presenting with acute ST within the prospective randomized TOTAL trial.
Methods: Efficacy of thrombus aspiration in patients presenting with acute ST-elevation myocardial infarction (STEMI) was evaluated in the prospectively randomized TOTAL trial. The angiograms of patients with previous percutaneous intervention were reviewed to identify patients with acute ST on presentation with STEMI. Baseline data and outcome at 365 days was compared in the group with ST with that of patients with STEMI not involving a stented artery (non-ST). The primary outcome was major adverse cardiac events (MACE), a composite of death from cardiovascular causes, recurrent myocardial infarction(MI), cardiogenic shock, or New York Heart Association class IV heart failure at 365 days.
Results: A total of 776 patients with previous PCI were identified and angiographic images were reviewed, 355 (46%) of these demonstrated acute ST as the cause of their STEMI. A significant difference was demonstrated in gender, presence of hypertension, diabetes, previous MI, peripheral disease (p<0.001) and anterior MI (p=0.033), all increased within the ST group. There was no significant difference in the primary outcome between the two groups (ST 7.8% vs nST 10.1%, p=0.101). In particular, the 2 groups were similar in rates of cardiovascular death (3.4% vs 3.7 %) and recurrent MI (2.8 vs 2.4%).
Conclusions: In this large prospective trial, acute ST was present in 46% of patients with previous PCI presenting with STEMI. However, there was no increased risk of mortality or MACE, compared to a non-ST population. This was despite a more adverse risk profile and is contrary to published registry data.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Novel Developments in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1194-142
- 2017 American College of Cardiology Foundation