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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Clinical outcomes following ST-elevation myocardial infarction secondary to stent thrombosis treated by percutaneous
Samer Noaman1,2,3, Jessica O'Brien2, Nick Andrianopoulos4
1University of Melbourne, Melbourne, Victoria, Australia.
Insights
Patients with ST-elevation myocardial infarction (STEMI) due to stent thrombosis (ST) had similar short-term outcomes compared to those with STEMI from de novo lesions after percutaneous coronary intervention (PCI). This finding addresses stent thrombosis complications in STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Stent thrombosis (ST) is a rare but serious complication following percutaneous coronary intervention (PCI).
- Limited data exists on the clinical outcomes of ST-elevation myocardial infarction (STEMI) secondary to ST.
- Understanding ST's impact is crucial for managing STEMI patients treated with PCI.
Purpose of the Study:
- To compare clinical outcomes of STEMI patients with ST versus those with de novo lesions.
- To assess the 30-day all-cause mortality in STEMI patients with ST after PCI.
- To identify predictors of mortality in STEMI patients with ST.
Main Methods:
- A prospective registry study of STEMI patients treated with PCI from 2005 to 2013.
- Patients were categorized into ST group (STEMI due to ST) and de novo group (STEMI due to de novo lesions).
- Primary endpoint was 30-day all-cause mortality; multivariate analysis was performed.
Main Results:
- The ST group (n=128) had higher rates of comorbidities compared to the de novo group (n=3,835).
- Very-late ST was the most common type within the ST group.
- No significant difference in 30-day mortality was observed between the ST and de novo groups (4.7% vs. 7.1%).
- ST was not an independent predictor of 30-day mortality on multivariate analysis.
Conclusions:
- Short-term prognosis for STEMI patients with ST treated by PCI is comparable to those with de novo lesions.
- This suggests that successful PCI mitigates the increased risk associated with stent thrombosis in the acute STEMI setting.
Objectives:
To assess the clinical outcomes of patients presenting with ST-elevation myocardial infarction (STEMI) secondary to stent thrombosis (ST) compared to those presenting with STEMI secondary to a de novo culprit lesion and treated by percutaneous coronary intervention (PCI).
Background:
ST is an infrequent but serious complication of PCI with substantial associated morbidity and mortality, however with limited data.
Methods:
We studied consecutive patients who underwent PCI for STEMI from 2005 to 2013 enrolled prospectively in the Melbourne Interventional Group registry. Patients were divided into two groups: the ST group comprised patients where the STEMI was due to ST and the de novo group formed the remainder of the STEMI cohort and all patients were treated by PCI. The primary endpoint was 30-day all-cause mortality.
Results:
Compared to the de novo group (n = 3,835), the ST group (n = 128; 3.2% of STEMI) had higher rates of diabetes, hypertension and dyslipidemia, established cardiovascular diseases, myocardial infarction, and peripheral vascular disease, all p < .01. Within the ST group, very-late ST was the most common form of ST, followed by late and early ST (64, 19, and 17%, respectively). There was no significant difference in the primary outcome between the ST group and the de novo group (4.7 vs. 7.1%, p = .29). On multivariate analysis, ST was not an independent predictor of 30-day mortality (odds ratio: 0.62, 95% confidence interval: 0.07-1.09, p = .068).
Conclusion:
The short-term prognosis of patients with STEMI secondary to ST who were treated by PCI was comparable to that of patients with STEMI due to de novo lesions.
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