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Contemporary Trends, Characteristics, and Outcomes of Patients Undergoing Percutaneous Coronary Intervention for
Ayman Elbadawi1, Angel Chen2, Daniel Wojdyla2
1Division of Cardiology, Christus Good Shepherd Medical Center, Longview, Texas, USA; Department of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA.
Insights
Stent thrombosis (ST) frequency remained stable despite new treatments. ST during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is linked to increased adverse outcomes, including mortality and bleeding.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Public Health Research
Background:
- Limited data exist on stent thrombosis (ST) trends and outcomes with modern treatments like potent P2Y12 inhibitors and advanced drug-eluting stents.
- Contemporary understanding of ST requires updated analysis in the context of current therapeutic advancements.
Purpose of the Study:
- To investigate the temporal trends, patient characteristics, and in-hospital outcomes of stent thrombosis (ST) among patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) in the United States.
- To compare outcomes of PCI for ST versus non-ST in a large, contemporary patient cohort.
Main Methods:
- Utilized the National Cardiovascular Data Registry CathPCI registry to identify patients undergoing PCI for AMI from April 2018 to June 2023.
- Employed linear regression to assess temporal trends in PCI for ST rates.
- Applied multivariable logistic regression to compare in-hospital outcomes between PCI for ST and non-ST groups.
Main Results:
- Out of 2,023,032 patients undergoing PCI for AMI, 2.8% (57,268) had ST.
- No significant temporal change in the frequency of PCI for ST was observed during the study period.
- PCI for ST was associated with significantly higher rates of major adverse cardiac events (aOR: 1.24), all-cause mortality (aOR: 1.17), recurrent MI (aOR: 1.80), and major bleeding (aOR: 1.18) compared to non-ST PCI.
Conclusions:
- The frequency of percutaneous coronary intervention for stent thrombosis has not changed over time in the contemporary era.
- Most cases of stent thrombosis occurred early or very late after the initial procedure.
- Percutaneous coronary intervention for stent thrombosis is associated with a higher risk of in-hospital adverse events.
Background:
There are limited data regarding the temporal trends and outcomes of stent thrombosis (ST) in the contemporary era of potent P2Y12 inhibitors, newer generation drug-eluting stents, and intracoronary imaging.
Objectives:
The aim of this study was to examine the trends, characteristics, and outcomes of patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) for ST in the United States.
Methods:
Patients undergoing PCI for AMI between April 2018 and June 2023 were identified from the National Cardiovascular Data Registry CathPCI registry. The rates of PCI for ST were evaluated over time using linear regression. In-hospital outcomes of PCI for ST vs no ST were compared using multivariable logistic regression.
Results:
Among 2,023,032 patients undergoing PCI for AMI, 57,268 (2.8%) procedures were for ST. The timing of ST was early (18,189 of 55,351 [31.8%]), late (8,825 of 55,351 [15.4%]), very late (28,337 of 55,351 [49.5%]), or unknown (1,917 of 55,351 [3.4%]). There was no temporal change in the frequency of PCI for ST during the study period. PCI for ST was associated with a higher incidence of major adverse cardiac events (adjusted OR [aOR]: 1.24; 95% CI: 1.19-1.29), all-cause mortality (aOR: 1.17; 95% CI: 1.12-1.22), recurrent myocardial infarction (aOR: 1.80; 95% CI: 1.63-1.98), and major bleeding (aOR: 1.18; 95% CI: 1.15-1.22) compared with PCI for non-ST.
Conclusions:
In this contemporary, nationwide, real-world analysis, there was no temporal change in the frequency of PCI for ST. Most STs were early or very late. PCI for ST was associated with a higher rate of in-hospital adverse outcomes.
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