The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Incidence and predictors of outcomes after a first definite coronary stent thrombosis

DOI: 10.4244/EIJ-D-19-00219

1. Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands
2. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
3. Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands
4. Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands
5. Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands
6. Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands
7. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
8. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
9. Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands
10. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
11. Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands, Netherlands
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Aims: Stent thrombosis (ST) is a rare but potentially fatal complication of coronary artery stenting. Little is known about the optimal treatment strategy at the time of a ST event. We identified the incidence and predictors of adverse cardiac events after treatment of a definite ST. 

Methods and results: 695 patients with definite ST were included between 1996 and 2017 in 2 academic medical centres. The primary endpoint was the composite of cardiac death, myocardial infarction (MI) and target vessel revascularization (TVR) (MACE). Mean age was 62.8 ± 12.1 years and 76.3% were male. ST occurred at a median of 22 days (IQR 3-551 days); 50.8% were early and 49.2% were late/very late ST. At 60 months follow-up, MACE was 43.7%, cardiac death 19.5%, MI 17.9%, TVR 24.8%, and repeat definite ST was 12.1% (10.5% in target vessel). Independent predictors of MACE were cardiogenic shock (HR 2.54; 95%CI 1.75-3.70; p<0.001), ST in LAD (HR 1.76; 95%CI 1.32-2.35; p<0.001) prior CVA/TIA (HR 1.68; 95%CI 1.08-2.62; p=0.020), peripheral vascular disease (HR 1.55; 95%CI 1.00-2.39; p=0.046), multivessel disease (HR 1.53; 95%CI 1.12-2.08; p=0.007), and final TIMI flow 2-3 (HR 0.54; 95% CI 0.34-0.85; p=0.009). No specific treatment of ST influenced MACE, however, new generation P2Y12 inhibitors reduced the risk of MI (HR 0.56; 95% CI 0.32-0.99; p=0.049). 

Conclusions: The incidence of adverse events remains high after a first episode of ST. New generation P2Y12 inhibitors reduce the risk of MI. Additional stenting, GpIIb/IIIa inhibitors and thrombectomy did not improve outcomes following ST.

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