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ST-segment Elevation Myocardial Infarction Resulting from Stent Thrombosis in Contemporary Real-World Practice

Yumiko Kanei1, Kishore Nallu1, Parth Makker1

  • 1Department of Cardiology, Mount Sinai Beth Israel, New York, New York.

The International Journal of Angiology : Official Publication of the International College of Angiology, Inc
|March 4, 2017
PubMed

Insights

Stent thrombosis (ST), a serious complication after coronary stenting, often occurs very late and is linked to second-generation drug-eluting stents (DES). This highlights the need for ongoing vigilance even with newer treatments.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Stent thrombosis (ST) remains a critical complication following percutaneous coronary intervention, despite advances in drug-eluting stents (DES) and antiplatelet therapies.
  • ST-segment elevation myocardial infarction (STEMI) due to ST continues to be observed in current clinical practice, necessitating further investigation into its characteristics and risk factors.

Purpose of the Study:

  • To analyze the clinical presentation, timing, and associated factors of stent thrombosis (ST) in patients presenting with ST-segment elevation myocardial infarction (STEMI).
  • To compare characteristics of patients with ST-STEMI versus those with STEMI due to de novo lesions.

Main Methods:

  • A retrospective analysis of 527 patients presenting with STEMI was conducted.
  • Fifty-seven patients with angiographically confirmed ST were compared to patients with STEMI from de novo lesions.
  • Data reviewed included stent type, timing of ST, and antiplatelet therapy use.

Main Results:

  • Patients with ST had a higher prevalence of comorbidities (hypertension, diabetes, coronary artery disease) and lower left ventricular ejection fraction compared to the control group.
  • The most common presentation of ST was "very late" (56%), often associated with previous second-generation DES (40%).
  • Dual antiplatelet therapy (DAPT) use varied significantly by ST timing, with 82% of early ST patients on DAPT versus 22% of very late ST patients; 12% of ST events occurred after DAPT cessation.

Conclusions:

  • Very late stent thrombosis, particularly with second-generation DES, is a significant issue in contemporary practice.
  • The findings underscore the importance of considering stent type and duration of antiplatelet therapy in managing patients at risk for ST.
  • While in-hospital mortality showed no significant difference, the characteristics of ST suggest evolving challenges in preventing this complication.

Keywords:
cardiac catheterizationcoronary interventionmyocardial infarctionneoatherosclerosisstent

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