Temporal patterns, characteristics, and predictors of clinical outcomes in patients undergoing percutaneous coronary intervention for stent thrombosis

DOI: 10.4244/EIJ-D-22-00049

Mohamed Mohamed
Mohamed O. Mohamed1,2, PhD; Alex Sirker3, PhD; Alaide Chieffo4, MD; Pablo Avanzas5, MD, PhD; James Nolan6, MD; Muhammad Rashid1,6, MRCP; Mohamed Dafaalla1,6, MRCP; Saadiq Moledina1,6, MRCP; Peter Ludman7, MD; Tim Kinnaird8, MD; Mamas A. Mamas1,6, DPhil
1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; 2. Institute of Health Informatics, University College London, London, United Kingdom; 3. Department of Cardiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; 4. Department of Cardiology, San Raffaele Hospital, Milan, Italy; 5. Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain; 6. Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; 7. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; 8. Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom

Background: There are limited data on the outcomes of percutaneous coronary intervention (PCI) following stent thrombosis (ST) and differences exist based on timing.

Aims: Our aim was to study the rates of PCI procedures for an ST indication among all patients admitted for PCI at a national level and to compare their characteristics and procedural outcomes based on ST timing.

Methods: All PCI procedures in England and Wales (2014-2020) were retrospectively analysed and stratified by the presence of ST into four groups: non-ST, early ST (0-30 days), late ST (>30-360 days), very late ST (>360 days). Multivariable logistic regression models were performed to assess the odds ratios (OR) of in-hospital MACCE (major adverse cardiovascular and cerebrovascular events, a composite of mortality, acute stroke and reinfarction) and mortality.

Results: Overall, 7,923 (1.4%) procedures were for ST indication, most commonly for early ST (n=4,171; 52.6%), followed by very late ST (n=2,801; 35.4%) and late ST (n=951; 12.0%). The rate of PCI for ST declined between 2014 and 2020 (1.7 to 1.4%; p<0.001). Early ST was the only subgroup associated with increased odds of MACCE (OR 1.22, 95% CI: 1.05-1.41), all-cause mortality (OR 1.21, 95% CI: 1.07-1.36) and reinfarction (OR 2.48, 95% CI: 1.48-4.14), compared with non-ST indication. The odds of mortality were significantly reduced in ST patients with the use of intravascular imaging (OR 0.66, 95% CI: 0.48-0.92) and newer P2Y12 inhibitors (ticagrelor: OR 0.69, 95% CI: 0.49-0.95; prasugrel: OR 0.54, 95% CI: 0.30-0.96).

Conclusions: PCI for ST has declined in frequency over a 7-year period, with most procedures performed for early ST. Among the different times of ST onset, only early ST is associated with worse clinical outcomes after PCI. Routine use of intravascular imaging and newer P2Y12 inhibitors could further improve outcomes in this high-risk procedural group.

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clinical researchprior pcistent thrombosis
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