Prevalence and outcomes of early versus late stent thrombosis presenting as ST-segment elevation myocardial
Gilad Margolis1, Michael Barkagan, Nir Flint
1Department of Cardiology Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Early stent thrombosis (ST) presenting as ST-segment elevation myocardial infarction (STEMI) significantly increases 30-day mortality. Late ST or de-novo thrombosis does not impact long-term survival. This highlights the critical early risk associated with ST in STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes
Background:
- Stent thrombosis (ST) outcomes vary based on timing.
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Primary percutaneous coronary intervention is a key treatment for STEMI.
Purpose of the Study:
- To evaluate the incidence and prognostic implications of early versus late ST in STEMI patients.
- To compare in-hospital and long-term outcomes for different ST timings.
- To identify early ST as an independent predictor of mortality.
Main Methods:
- Retrospective analysis of 1722 STEMI patients undergoing primary percutaneous coronary intervention.
- ST classified as early or late using Academic Research Consortium definitions.
- Evaluation of in-hospital adverse events and long-term mortality.
Main Results:
- Definite ST occurred in 4.8% of patients (35 early, 48 late).
- Early ST was associated with more in-hospital adverse events and higher 30-day mortality (11% vs. 0% for late ST, 2% for no ST).
- Early ST independently predicted 30-day mortality (OR 6.6, P=0.033); no difference in long-term mortality was observed.
Conclusions:
- Early ST presenting as STEMI is an independent predictor of increased 30-day mortality.
- Late ST or de-novo coronary thrombosis shows no significant difference in long-term mortality compared to early ST.
- Timely identification and management of early ST are crucial for improving STEMI patient outcomes.
Objectives:
Previous reports showed inconsistencies in the outcomes and prognosis of stent thrombosis (ST) when stratified according to the timing of its occurrence. We evaluated the incidence and possible prognostic implications of early and late ST presenting as ST-segment elevation myocardial infarction (STEMI) in a large cohort of consecutive patients undergoing a primary percutaneous coronary intervention.
Materials And Methods:
We retrospectively studied 1722 STEMI patients treated by primary percutaneous coronary intervention. The presence of ST was determined using the Academic Research Consortium definitions. Patients were evaluated for the time of ST (early, late) and for in-hospital outcomes as well as long-term mortality.
Results:
A total of 83/1722 (4.8%) patients showed definite ST, 35 (42%) of whom had early ST and 48 (58%) had late ST. Patients with early ST had more adverse events during hospitalization as well as higher 30-day mortality compared with patients with late or no ST (11 vs. 0 vs. 2%, P<0.001). In a multivariate logistic regression model, early ST was an independent predictor of 30-day mortality (odds ratio 6.6, 95% confidence interval 1.1-38, P=0.033). No significant difference was observed in long-term mortality between patients presenting with early, late ST, or no ST.
Conclusion:
Early ST manifested as STEMI is associated independently with a higher 30-day mortality rate in comparison with STEMI because of late ST or de-novo coronary thrombosis.
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