Long-term clinical outcome after a first angiographically confirmed coronary stent thrombosis: an analysis of 431 cases
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Published on: May 14, 2013
Jochem W van Werkum1, Antonius A C M Heestermans, Fleur I de Korte
1Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands.
Insights
Long-term outcomes after definite stent thrombosis (ST) are poor, with high rates of cardiac death and recurrent ST. Predictors include diabetes, low ejection fraction, and complex lesion characteristics.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Limited data exist on long-term clinical outcomes following angiographically confirmed definite stent thrombosis (ST).
- Understanding these outcomes is crucial for managing patients post-ST.
Purpose of the Study:
- To evaluate the long-term clinical outcomes in patients experiencing a first definite stent thrombosis (ST).
- To identify predictors associated with adverse events after definite ST.
Main Methods:
- A multicenter registry enrolled 431 consecutive patients with definite ST.
- Follow-up data were collected to assess primary (cardiac death and recurrent ST) and secondary endpoints.
- Predictors of the primary endpoint were analyzed using multivariable analysis.
Main Results:
- The primary endpoint occurred in 111 patients, with cumulative event rates reaching 27.9% at 3 years.
- High rates of recurrent ST (18.8%), myocardial infarction (21.3%), and target-vessel revascularization (32.0%) were observed.
- Independent predictors for adverse outcomes included diabetes mellitus, low ejection fraction, long stent length, complex lesions, poor post-PCI TIMI flow, and additional stent implantation.
Conclusions:
- Long-term clinical outcome after a first definite ST is unfavorable, characterized by high mortality and recurrence rates.
- Specific patient and procedural factors, including diabetes, impaired LV function, complex coronary anatomy, and procedural characteristics, are associated with poor outcomes.
Background:
There are limited data on the long-term clinical outcome after an angiographically confirmed (definite) stent thrombosis (ST).
Methods And Results:
Four hundred thirty-one consecutive patients with a definite ST were enrolled in this multicenter registry. The primary end point was the composite of cardiac death and definite recurrent ST. Secondary end points were all-cause death, cardiac death, definite recurrent ST, definite and probable recurrent ST, any myocardial infarction, and any target-vessel revascularization. The primary end point occurred in 111 patients after a median follow-up of 27.1 months. The estimated cumulative event rates at 30 days and 1, 2, and 3 years were 18.0%, 23.6%, 25.2%, and 27.9%, respectively. The cumulative incidence rates of definite recurrent ST, definite or probable recurrent ST, any myocardial infarction, and any target-vessel revascularization were 18.8%, 20.1%, 21.3%, and 32.0%, respectively, at the longest available follow-up. Independent predictors for the primary end point were diabetes mellitus, total stent length, severe calcification, American College of Cardiology/American Heart Association B2-C lesions, TIMI (Thrombolysis In Myocardial Infarction) flow grade <3 after percutaneous coronary intervention, and left ventricular ejection fraction <45%. The implantation of an additional coronary stent during the first ST was also associated with unfavorable outcome. Clinical outcome was not affected by the type of previously implanted stent (drug-eluting or bare-metal stent) or the category of ST (early versus late).
Conclusions:
The long-term clinical outcome after a first definite ST is unfavorable, with a high mortality and recurrence rate. Diabetes mellitus, left ventricular ejection fraction <45%, long total stent length, complex coronary lesions, TIMI flow grade <3 after percutaneous coronary intervention, and implantation of an additional coronary stent during the emergent percutaneous coronary intervention for the ST were associated with this unfavorable outcome.
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