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The outcome of primary percutaneous coronary intervention for stent thrombosis causing ST-elevation myocardial

Mehmet Ergelen1, Sevket Gorgulu, Huseyin Uyarel

  • 1Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Cardiology Department, Istanbul-Turkey. drmerg@hotmail.com

American Heart Journal
|April 6, 2010
PubMed

Insights

Primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) due to stent thrombosis (ST) is less effective. Patients with ST-STEMI face higher in-hospital and long-term mortality risks compared to those with de novo STEMI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Limited data exist on primary percutaneous coronary intervention (PCI) effectiveness for ST-elevation myocardial infarction (STEMI) caused by stent thrombosis (ST).
  • Stent thrombosis is a serious complication following PCI, leading to recurrent myocardial infarction and increased mortality.

Purpose of the Study:

  • To investigate the efficacy and outcomes of primary PCI in STEMI patients with ST.
  • To compare the results of primary PCI for ST-STEMI versus de novo STEMI in a large patient cohort.

Main Methods:

  • Retrospective analysis of 2,644 consecutive STEMI patients undergoing primary PCI.
  • Primary endpoint: successful angiographic reperfusion (Thrombolysis In Myocardial Infarction grade III flow).
  • Secondary endpoints: cardiovascular death and reinfarction rates (in-hospital and long-term).

Main Results:

  • Stent thrombosis accounted for STEMI in 4.4% of patients (118 cases).
  • Angiographic success was lower in ST-STEMI patients (76.3%) compared to de novo STEMI (84.8%, P = .01).
  • ST-STEMI patients exhibited higher in-hospital (10.2% vs 5.3%, P = .02) and long-term (17.4% vs 10.5%, P = .02) cardiovascular mortality.
  • Long-term reinfarction rates were also significantly higher in ST-STEMI patients (15.6% vs 9.5%, P = .03).

Conclusions:

  • Primary PCI is less effective for treating STEMI caused by ST.
  • Patients with ST-STEMI face significantly increased risks of both in-hospital and long-term mortality compared to those with de novo STEMI.
Abstract

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