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Published on: May 28, 2019
Stent Thrombosis after Rescue Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction
Khalid Bin Thani1, Fajer Al-Moosa1, Eman Murad1
1Salmaniya Medical Complex, Division of Cardiology, Department of Internal Medicine, Manama, Kingdom of Bahrain.
Insights
Stent thrombosis (ST) is an infrequent but serious complication in ST-segment elevation myocardial infarction (STEMI) patients undergoing rescue percutaneous coronary intervention (PCI). The overall ST rate was 13.7% within two years post-stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular emergency.
- Rescue percutaneous coronary intervention (PCI) is employed in STEMI cases not responding to initial therapy.
- Stent thrombosis (ST) is a rare but severe complication following PCI.
Purpose of the Study:
- To determine the incidence of stent thrombosis (ST).
- To analyze ST in patients with acute STEMI after rescue PCI.
- To evaluate ST rates in a Middle Eastern population.
Main Methods:
- Observational study of 510 consecutive STEMI patients over 2 years.
- Patients received thrombolytic therapy; 100 underwent rescue PCI with stenting (DES or BMS).
- Outcomes included ST, death, re-infarction, and acute coronary syndrome.
Main Results:
- Overall ST rate was 13.7% (definite 5.5%, probable 7.3%, possible 0.9%).
- Incidence of acute, sub-acute, late, and very late ST were 0.9%, 0.9%, 2.8%, and 8.3% respectively.
- ST was associated with prior PCI, prior coronary artery bypass grafting (CABG), and heart failure history.
Conclusions:
- Stent thrombosis is infrequent but carries significant consequences in STEMI patients post-rescue PCI.
- The study highlights the importance of monitoring for ST in the first two years after stent implantation.
- Findings emphasize risk factors associated with ST in this patient cohort.
Main Problem:
To determine the incidence of coronary stent thrombosis (ST) in patients with acute ST segment elevation myocardial infarction (STEMI) after rescue percutaneous coronary intervention (PCI).
Methods:
An observational study looking at the incidence of ST in a middle-eastern population. A total of 510 consecutive patients presented with ST-segment elevation myocardial infarction (STEMI) were enrolled and underwent thrombolytic therapy with a total follow-up period of 2 years. Study outcomes were ST, death, re-infarction or acute coronary syndrome requiring coronary angiography and PCI.
Results:
A total of 510 patients enrolled, all diagnosed with STEMI and underwent thrombolytic therapy. Only 100 subjects underwent rescue PCI with intra-coronary stenting, including 54 patients with drug-eluting stent (DES) and 46 patients with bare metal stent (BMS). During the study period and follow-up, the overall rate of ST was 13.7%, definite ST occurred in 6 patients (5.5%), probable ST in 8 patients (7.3%), and possible ST in one patient (0.9%), including 0.9% acute ST, 0.9% sub-acute ST, 2.8% late ST and 8.3% very late ST. Patients with ST were likely to have prior PCI (p=0.001), prior coronary artery bypass grafting (CABG) (p=0.002) and history of heart failure (p=0.04).
Conclusion:
ST is infrequent event with major consequences in patients presenting with STEMI in the first 2 years after stent implantation.
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