Early Stent Thrombosis Evaluated in STEMI Patients Undergoing Primary PCI
July 31, 2017—A study of early stent thrombosis in acute myocardial infarction patients treated with primary percutaneous coronary angioplasty was published online by Kuljit Singh, MD, et al in Catheterization and Cardiovascular Interventions.
The investigators sought to evaluate the incidence, predictors, and outcomes of early stent thrombosis in real-world patients experiencing ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). The background of the study is that, to date, there is limited information on angiographic and clinical predictors of early stent thrombosis in these patients.
As summarized in Catheterization and Cardiovascular Interventions, the investigators used the University of Ottawa Heart Institute STEMI registry to identify all the patients presenting with STEMI between June 2004 and January 2011 who underwent primary PCI as the primary mode of revascularization. Diagnosis of stent thrombosis was made per the standard definition proposed by the Academic Research Consortium.
The incidence of early stent thrombosis was 1% among 2,303 patients treated with primary PCI. Definite and probable early stent thrombosis occurred in 22 and two patients, respectively. Patients with early stent thrombosis had higher in-hospital (P = .03) and 30-day (P = .048) mortality rates. The rate of cardiogenic shock (P = .0006) and cerebrovascular accident (P = .0004) was also greater in the early stent thrombosis group. Smaller stent diameter and less use of intracoronary glycoprotein IIb/IIIa inhibitor were associated with a higher rate of early stent thrombosis. There was a trend of higher bivalirudin use in the stent thrombosis group, which did not reach significance (P = .07). On intravascular ultrasound imaging, stent malapposition and uncovered plaque area were noted in six out of 11 cases.
The investigators concluded that the incidence of early stent thrombosis in the primary PCI cohort is low. However, it is still associated with higher mortality and morbidity. Small stent diameter and disuse of intracoronary glycoprotein IIb/IIIa inhibitor may be associated with early stent thrombosis, noted the investigators in Catheterization and Cardiovascular Interventions.