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Bare metal stent thrombosis in patients with acute coronary syndrome

Fathia Mghaieth Zghal1, Aymen Amri, Mohamed Sami Mourali

  • 1Cardiology Department, Rabta Hospital of Tunis, Tunis, Tunisia. fathiazghal@yahoo.com

Circulation Journal : Official Journal of the Japanese Circulation Society
|January 27, 2012
PubMed

Insights

Stent thrombosis (ST) incidence is higher in acute coronary syndrome (ACS) patients undergoing stenting. Key predictors include fever during PCI, premature clopidogrel cessation, and smoking resumption, highlighting the need for improved patient education and secondary prevention.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Public Health

Background:

  • Patients with acute coronary syndrome (ACS) face elevated risks of stent thrombosis (ST) post-coronary stenting compared to elective procedures.
  • Limited research exists on ST incidence and predictors specifically within the ACS patient population.

Purpose of the Study:

  • To determine the incidence of definite stent thrombosis (ST) in patients with acute coronary syndrome (ACS) undergoing coronary stenting.
  • To identify independent predictors of ST in this high-risk patient group.

Main Methods:

  • A single-center study involving 611 consecutive Tunisian patients with ACS who received bare metal stents (BMS).
  • Follow-up was conducted for a median of 16 months to assess Academic Research Consortium (ARC) definite ST.
  • Statistical analysis identified independent predictors using hazard ratios (HR) and 95% confidence intervals (95%CI).

Main Results:

  • The overall incidence of ARC definite ST was 3.5%.
  • Patients with ST-elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) had a higher ST incidence of 9.2%.
  • Independent predictors of ST included fever during PCI, premature clopidogrel cessation, smoking resumption, primary PCI, rescue PCI, smaller reference vessel diameter (<2.8mm), poor pre-PCI TIMI flow (<2), and visible thrombus.

Conclusions:

  • The incidence of ST in ACS patients is notably higher than previously reported.
  • Premature discontinuation of clopidogrel and resuming smoking post-PCI are significant contributing factors to ST.
  • Enhanced patient education and secondary prevention strategies are crucial for mitigating ST risk in ACS patients.
Abstract

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