Predictors of Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention
DOI:
https://doi.org/10.37762/jgmds.10-2.379Keywords:
Acute Stent Thrombosis, Myocardial Infarction, Risk FactorsAbstract
OBJECTIVES
To identify the specific predictors of acute stent thrombosis in patients after primary percutaneous coronary intervention.
METHODOLOGY
This retrospective study was carried out at the Department of Cardiology Hayatabad Medical Complex Peshawar from 1st January to 30th June 2022. All consecutive patients with an angiographically confirmed stent thrombosis were enrolled. Patients gave informed consent for the inclusion of data in this registry. Stent thrombosis was categorized according to the timing of the event as acute (occurrence within the first 24 hours after the index procedure).
RESULTS
A total of 400 patients were included in the study. Age ranged between 35-70 years, with a mean age of 52.5. There were 260(65%) males and 140(35%) females, with male to female ratio of 1.8:1. All patients underwent primary PCI with stent implantation. According to the elapsed time since stent implantation, 42(10.5%) patients presented with acute stent thrombosis after primary percutaneous coronary intervention. The mean time to develop acute stent thrombosis after primary PCI was ±4.5 hours (range 3-6 hours). In most STEMI patients, 340(85%) received a loading dose of clopidogrel at the time of the index PCI. In 23(54.7%) patients, acute stent thrombosis occurred within 6 hours, 10(23.8%) within 12 hours, 6(14.2%) within 18 hours and 3(7.1%) after clopidogrel loading.
CONCLUSION
Inadequate stent expansion or mal-opposition, diabetes mellitus, chronic kidney disease, and female gender were the strong predictors of acute stent thrombosis.
Downloads
Metrics
References
Gao N, Qi X, Dang Y, Li Y, Wang G, Liu X, Zhu N, Fu J. Association between total ischemic time and in-hospital mortality after emergency PCI in patients with acute ST-segment elevation myocardial infarction: a retrospective study. BMC Cardiovascular Disorders 2022; 22(1):1-9
Sappa R, Grillo MT, Cinquetti M, Prati G, Spedicato L, Nucifora G, et al. Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. Int J Cardiol 2017; 249:112-8
Talreja K, Sheikh K, Rahman A, Parkash C, Khan AA, Ahmed F, Karim M. Outcomes of Primary percutaneous coronary intervention in patients with a thrombolysis in myocardial infarction score of five or higher. Cureus 2020;12(7):23-9
Malik TF, Tivakaran VS: Percutaneous transluminal coronary angioplasty. StatPearls [Internet]. StatPearls Publishing, Treasure Island, FL; 2021
De Marzo V, D'amario D, Galli M, Vergallo R, Porto I: High-risk percutaneous coronary intervention: how to define it today?. Minerva Cardioangiol. 2018, 66:576-93. 10.23736/S0026-4725.18.04679-0
Yuan J, Xu GM: Early and late stent thrombosis in patients with versus without diabetes mellitus following percutaneous coronary intervention with drug-eluting stents: a systematic review and meta-analysis. Am J Cardiovasc Drugs. 2018, 18:483-92. 10.1007/s40256-018-0295-y
Hara H, Ono M, Kawashima H, Onuma Y, Serruys PW: Trade-off between bleeding and thrombotic risk in patients with academic research consortium for high bleeding risk. JAMA Cardiol. 2021, 6:1092-4. 10.1001/jamacardio.2021.1558
Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Gabriel Steg P, Morel MA, Mauri L, Vranckx P, McFadden E. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007 May 1;115(17):2344-51
Cheneau E, Leborgne L, Mintz GS, Kotani JI, Pichard AD, Satler LF, Canos D, Castagna M, Weissman NJ, Waksman R. Predictors of subacute stent thrombosis: results of a systematic intravascular ultrasound study. Circulation. 2003 Jul 8;108(1):43-7
Cheneau E, Satler LF, Escolar E, Suddath WO, Kent KM, Weissman NJ, Waksman R, Pichard AD. Underexpansion of sirolimus‐eluting stents: incidence and relationship to delivery pressure. Catheterization and cardiovascular interventions. 2005 Jun;65(2):222-6
Briguori C, Tobis J, Nishida T, Vaghetti M, Albiero R, Di Mario C, Colombo A. Discrepancy between angiography and intravascular ultrasound when analysing small coronary arteries. European heart journal. 2002 Feb 1;23(3):247-54
Kuchulakanti PK, Chu WW, Torguson R, Ohlmann P, Rha SW, Clavijo LC, Kim SW, Bui A, Gevorkian N, Xue Z, Smith K. Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus-and paclitaxel-eluting stents. Circulation. 2006 Feb 28;113(8):1108-13
Dewilde W, Ten Berg J. Design and rationale of the WOEST trial: What is the Optimal antiplatElet and anticoagulant therapy in patients with oral anticoagulation and coronary StenTing (WOEST). American heart journal. 2009 Nov 1;158(5):713-8
Uren NG, Schwarzacher SP, Metz JA, Lee DP, Honda Y, Yeung AC, Fitzgerald PJ, Yock PG. Predictors and outcomes of stent thrombosis. An intravascular ultrasound registry. European heart journal. 2002 Jan 1;23(2):124-32
Manoukian SV, Feit F, Mehran R, Voeltz MD, Ebrahimi R, Hamon M, Dangas GD, Lincoff AM, White HD, Moses JW, King SB. Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY Trial. Journal of the American College of Cardiology. 2007 Mar 27;49(12):1362-8
Breet NJ, van Werkum JW, Bouman HJ, Kelder JC, Ruven HJ, Bal ET, Deneer VH, Harmsze AM, van der Heyden JA, Rensing BJ, Suttorp MJ. Comparison of platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation. Jama. 2010 Feb 24;303(8):754-62
Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT, Walker JR, Antman EM, Macias WL, Braunwald E, Sabatine MS. Cytochrome P450 genetic polymorphisms and the response to prasugrel: relationship to pharmacokinetic, pharmacodynamic, and clinical outcomes. Circulation. 2009 May 19;119(19):2553-60
Sibbing D, Stegherr J, Latz W, Koch W, Mehilli J, Dörrler K, Morath T, Schömig A, Kastrati A, von Beckerath N. Cytochrome P450 2C19 loss-of-function polymorphism and stent thrombosis following percutaneous coronary intervention. European heart journal. 2009 Apr 1;30(8):916-22
Wiviott, S.D., Braunwald, E., Angiolillo, D.J., Meisel, S., Dalby, A.J., Verheugt, F.W., Goodman, S.G., Corbalan, R., Purdy, D.A., Murphy, S.A. and McCabe, C.H., 2008. Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel–Thrombolysis in Myocardial Infarction 38. Circulation, 118(16), pp.1626-1636
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Ikram Ullah, Amir Rashid Qureshi, Sami Ullah, Mohammad Asghar Khan, Muhammad Salman, Hamid Ali Shah
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.