Author + information
- Daniel Jeffery1,
- Krishnaraj Rathod2,
- Ajay Jain3,
- Charles Knight3,
- Anthony Mathur3,
- Elliot Smith4,
- Roshan Weerackody1,
- Andrew Wragg3 and
- Daniel Jones3
Stent thrombosis (ST) is associated with substantial morbidity and mortality and consequently, causes significant concern amongst the interventional cardiology community. However, despite this concern, there are no guidelines or consensus on how to manage stent thrombosis and limited data regarding outcomes for these patients. The aim of this study was to describe differences in treatment and in-hospital mortality of early, late, and very late stent thrombosis (ST).
This was an observational cohort study of 6153 patients who underwent primary PCI from 2005 to 2016 with follow-up for a median of 4.2 years (IQR range: 1.8-5.4 years). We stratified events by timing of presentation: early (≤1 month), late (1 to 12 months), or very late (≥12 months) following stent implantation. The primary end-point was the first major adverse cardiac event (MACE) defined as death, non-fatal myocardial infarction, or target vessel revascularization.
During the study period, ST overall accounted for 6.7% (413/6153) of all STEMIs, this included 17.6% with early ST, 23.6% with late ST and 59.4% with very late ST. Subjects with early ST had a higher prevalence of diabetes, whereas subjects with very late ST had a lower prevalence of prior myocardial infarction. Management of stent thrombosis varied significantly based on the timing of the stent thrombosis with early ST being treated with POBA alone (43.2% drug eluting balloon) in 77% of cases versus 15% of cases in very late ST (>1 year) (P<0.0001). Variations were seen over time, with a significant increase in intravascular imaging over the treatment period (20% vs 65.1%, P<0.0001) and an increasing use of POBA for early ST over time. MACE outcomes reduced over the treatment period (54% vs 34.6%) with early (HR 2.70; 95% CI: 1.33-3.46; P<0.0001) and late (HR, 1.73; 95% CI: 1.31-2.38; P=0.006) thrombosis but not VLST (HR, 0.84; 95% CI: 0.60-1.56; P=0.466), being a predictor of MACE after multivariate adjustment.
Significant differences exist in the treatment and outcomes of early, late, and very late ST, with persistent adverse profiles despite treatment improvements.
CORONARY: Acute Coronary Syndromes