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Mortality after presentation with stent thrombosis is associated with time from index percutaneous coronary
Ehrin J Armstrong1, Thomas M Maddox1, Evan P Carey1
1VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Denver, CO.
Insights
Mortality risk after stent thrombosis (ST) varies by timing. Early ST (EST) carries the highest 30-day mortality, while very late ST (VLST) shows significantly lower risk compared to EST.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Stent thrombosis (ST) is a serious complication after percutaneous coronary intervention.
- The risk of mortality associated with ST may depend on the time elapsed since stent implantation.
- Early, late, and very late ST events may have distinct underlying mechanisms and clinical implications.
Purpose of the Study:
- To investigate the association between the timing of angiographically defined stent thrombosis (ST) and 30-day mortality.
- To compare mortality risks across early ST (EST), late ST (LST), and very late ST (VLST) presentations.
Main Methods:
- Retrospective analysis of 656 patients diagnosed with definite ST from the VA CART Program (2006-2012).
- ST was categorized as EST (≤30 days), LST (31-365 days), and VLST (>365 days) post-implantation.
- Log-rank tests and Cox regression models were used to assess unadjusted and adjusted 30-day mortality differences between ST timing groups.
Main Results:
- The cohort included 129 (20%) EST, 138 (21%) LST, and 389 (59%) VLST cases.
- Stent thrombosis timing was significantly associated with 30-day mortality (P=.04, adjusted).
- Unadjusted mortality was 13% for EST, 6% for LST, and 3% for VLST. Adjusted analysis showed significantly lower mortality for VLST (HR 0.38) and nonsignificantly lower for LST (HR 0.5) compared to EST.
Conclusions:
- Thirty-day mortality following definite ST is significantly influenced by the time from the initial percutaneous coronary intervention.
- VLST is associated with a significantly lower 30-day mortality risk compared to EST.
- These findings suggest that different pathophysiological mechanisms may underlie ST at various time points, impacting patient outcomes.
Background:
The risk of mortality for patients presenting to the cardiac catheterization laboratory with stent thrombosis (ST) may differ as a function of the timing from initial stent implantation. We hypothesized that the 30-day mortality would differ for angiographically defined early ST (EST), late ST (LST), and very late ST (VLST).
Methods:
All patients undergoing angiography for diagnosis and treatment of ST were identified by the Department of Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) Program from 2006 to 2012. Stent thrombosis occurring ≤30 days after stent implantation were defined as EST; 31 to 365 days as LST; and >365 days as VLST. Log-rank test and Cox proportional hazard regression modeling were used to describe unadjusted and adjusted differences in mortality between groups.
Results:
A total of 656 patients were diagnosed with angiographic definite ST with known timing. This cohort consisted of 129 (20%), 138 (21%), and 389 (59%) patients with EST, LST, and VLST, respectively. Over three fourths (76%) of VLST cases occurred >2 years after stent implantation. Stent thrombosis timing was significantly associated with 30-day mortality risk in unadjusted (P < .001) and adjusted (P = .04) analyses. Unadjusted mortality risk was 3% in VLST, 6% in LST, and 13% in EST. After multivariable adjustment, patients with LST had nonsignificantly lower 30-day mortality (hazard ratio [HR] for LST, 0.5; 95% CI, 0.2-1.2), whereas VLST had significantly lower 30-day mortality (HR for VLST, 0.38; 95% CI, 0.18-0.82) when compared with patients with EST.
Conclusions:
Thirty-day mortality after an angiographic definite ST presentation is associated with time from index percutaneous coronary intervention to ST. This relationship potentially reflects the differing mechanisms of ST that are postulated to predominate at different timeframes.