Clinical Predictors of In-Hospital Mortality among Patients with Stent Thrombosis Following Primary Percutaneous
Arshad Ali1, Samiullah Shakir2, Muhammad Ibaad Siddiqui3
1Department of Cardiology, Nottingham University Hospital, Nottingham, UK.
Insights
In patients experiencing stent thrombosis (ST) after primary percutaneous coronary intervention (PCI), acute hemodynamic compromise and procedural severity significantly predict in-hospital mortality. These findings highlight critical risk factors for adverse outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Stent thrombosis (ST) is a serious complication following percutaneous coronary intervention (PCI).
- Identifying predictors of mortality in ST patients is crucial for improving outcomes.
- Drug-eluting stents (DES) are commonly used in primary PCI.
Purpose of the Study:
- To identify clinical and procedural predictors of in-hospital mortality in patients with ST after primary PCI with DES.
- To analyze the association between various patient and procedural factors and mortality risk.
Main Methods:
- Observational cohort study conducted at a tertiary care cardiovascular hospital.
- Consecutive adult patients with angiographically confirmed ST post-primary PCI with DES were enrolled.
- Multivariable logistic regression was used to identify independent predictors of in-hospital mortality.
Main Results:
- In-hospital mortality was 25.0% among 148 patients.
- Predictors of increased mortality included temporary pacemaker use, intra-procedure slow-flow/no-reflow, advancing age, and higher heart rate.
- Each 1 mm Hg increase in systolic blood pressure was associated with a 5% reduction in mortality.
Conclusions:
- Acute hemodynamic compromise and procedural severity are strongly associated with in-hospital mortality in ST patients.
- These findings underscore the importance of monitoring hemodynamic status and procedural quality.
Objective:
To determine the clinical and procedural predictors of in-hospital mortality among patients presenting with stent thrombosis (ST) following primary percutaneous coronary intervention (PCI) with drug-eluting stents (DES) at a tertiary care cardiovascular hospital, Karachi, Pakistan.
Study Design:
An observational cohort study. Place and Duration of the Study: Department of IVC, National Institute of Cardiovascular Diseases, Karachi, Pakistan, from October 2023 to May 2024.
Methodology:
Consecutive adult patients who developed angiographically confirmed ST after primary PCI with DES were enrolled. ST was adjudicated according to the Academic Research Consortium criteria by an independent, blinded committee. Demographic variables, comorbidities, haemodynamic parameters, and procedural characteristics were recorded. The primary outcome was all-cause in-hospital mortality. Univariable analyses identified candidate predictors, which were entered into a multivariable logistic regression model.
Results:
Of 148 patients (mean age 57.6 ± 9.2 years; 79.7% male), in-hospital mortality was 25.0%. Independently increased odds of death were observed for temporary pacemaker use (adjusted OR 43.0; 95% CI: 3.99-464.02; p = 0.002), intra-procedure slow-flow/ no-reflow (OR 12.5; 95% CI: 2.04-76.10; p = 0.006), advancing age per year (OR 1.145; 95% CI: 1.040-1.261; p = 0.006), and higher heart rate per bpm (OR 1.040; 95% CI: 1.003-1.078; p = 0.033). Each 1 mm Hg increment in systolic blood pressure was associated with a 5% reduction in mortality (OR 0.950; 95% CI: 0.917-0.985; p = 0.005).
Conclusion:
In patients with ST following primary PCI, markers of acute haemodynamic compromise and procedural severity were strongly associated with in-hospital mortality.
Key Words:
Stent thrombosis, Primary percutaneous coronary intervention (PCI), In-hospital mortality, Risk factors.
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