OBJECTIVES: The aim of this study was to examine the incidence, correlates, and consequences of intra-procedural stent thrombosis (IPST) in patients with acute coronary syndromes (ACS). BACKGROUND: Stent thrombosis (ST) is a rare but serious complication of percutaneous coronary intervention (PCI). The Academic Research Consortium definition of ST excludes events occurring during PCI. METHODS: Angiograms from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) and HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trials were reviewed frame-by-frame at an independent core laboratory for the occurrence of IPST. Patients with versus without IPST were compared to identify baseline characteristics associated with IPST and demonstrate the independent association between IPST and adjudicated events at 30 days and 1 year. RESULTS: Intra-procedural ST occurred in 47 (0.7%) of 6,591 patients. The occurrence of IPST was associated with ST-segment elevation myocardial infarction presentation, high white blood cell count, treatment of thrombotic and bifurcation lesions, bivalirudin monotherapy, bail-out IIb/IIIa inhibitor use, and implantation of bare-metal (rather than drug-eluting) stents. Major adverse ischemic events were markedly higher in patients with versus without IPST, including mortality at 30 days (12.9% vs. 1.4%, p < 0.0001) and 1 year (12.9% vs. 3.1%, p < 0.0001). Out-of-lab Academic Research Consortium definite or probable ST also occurred significantly more often among IPST patients at 30 days (17.4% vs. 1.8%, p < 0.0001) and 1 year (19.9% vs. 2.7%, p < 0.0001). Intra-procedural ST was a significant independent predictor of 1-year mortality (hazard ratio: 3.86, 95% confidence interval: 1.66 to 9.00, p = 0.002). CONCLUSIONS: Intra-procedural ST is a relatively rare complication of PCI in ACS but is strongly associated with subsequent out-of-lab ST and mortality. Intra-procedural ST should be considered as a distinct category of ST and routinely reported, particularly for ACS patients.
OBJECTIVES: The aim of this study was to examine the incidence, correlates, and consequences of intra-procedural stent thrombosis (IPST) in patients with acute coronary syndromes (ACS). BACKGROUND: Stent thrombosis (ST) is a rare but serious complication of percutaneous coronary intervention (PCI). The Academic Research Consortium definition of ST excludes events occurring during PCI. METHODS: Angiograms from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) and HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trials were reviewed frame-by-frame at an independent core laboratory for the occurrence of IPST. Patients with versus without IPST were compared to identify baseline characteristics associated with IPST and demonstrate the independent association between IPST and adjudicated events at 30 days and 1 year. RESULTS: Intra-procedural ST occurred in 47 (0.7%) of 6,591 patients. The occurrence of IPST was associated with ST-segment elevation myocardial infarction presentation, high white blood cell count, treatment of thrombotic and bifurcation lesions, bivalirudin monotherapy, bail-out IIb/IIIa inhibitor use, and implantation of bare-metal (rather than drug-eluting) stents. Major adverse ischemic events were markedly higher in patients with versus without IPST, including mortality at 30 days (12.9% vs. 1.4%, p < 0.0001) and 1 year (12.9% vs. 3.1%, p < 0.0001). Out-of-lab Academic Research Consortium definite or probable ST also occurred significantly more often among IPST patients at 30 days (17.4% vs. 1.8%, p < 0.0001) and 1 year (19.9% vs. 2.7%, p < 0.0001). Intra-procedural ST was a significant independent predictor of 1-year mortality (hazard ratio: 3.86, 95% confidence interval: 1.66 to 9.00, p = 0.002). CONCLUSIONS: Intra-procedural ST is a relatively rare complication of PCI in ACS but is strongly associated with subsequent out-of-lab ST and mortality. Intra-procedural ST should be considered as a distinct category of ST and routinely reported, particularly for ACS patients.
Authors: Sofia Bergman; Moman A Mohammad; Stefan K James; Oskar Angerås; Henrik Wagner; Jens Jensen; Fredrik Scherstén; Ole Fröbert; Sasha Koul; David Erlinge Journal: J Am Heart Assoc Date: 2021-09-13 Impact factor: 6.106
Authors: Nso Nso; Mahmoud Nassar; Milana Zirkiyeva; Yolanda Mbome; Anthony Lyonga Ngonge; Solomon O Badejoko; Shahzad Akbar; Atika Azhar; Sofia Lakhdar; Laura M Guzman Perez; Yousef Abdalazeem; Vincent Rizzo; Most Munira Journal: Cureus Date: 2022-04-09
Authors: Xingji Liu; Binay Kumar Adhikari; Tianlong Chen; Yonggang Wang; Quan Liu; Shudong Wang Journal: J Int Med Res Date: 2021-03 Impact factor: 1.671
Authors: Matthew A Cavender; Deepak L Bhatt; Gregg W Stone; Harvey D White; Ph Gabriel Steg; C Michael Gibson; Christian W Hamm; Matthew J Price; Sergio Leonardi; Jayne Prats; Efthymios N Deliargyris; Kenneth W Mahaffey; Robert A Harrington Journal: Circulation Date: 2016-08-01 Impact factor: 29.690
Authors: Matthew A Cavender; Robert A Harrington; Gregg W Stone; Ph Gabriel Steg; C Michael Gibson; Christian W Hamm; Matthew J Price; Renato D Lopes; Sergio Leonardi; Efthymios N Deliargyris; Jayne Prats; Kenneth W Mahaffey; Harvey D White; Deepak L Bhatt Journal: Circ Cardiovasc Interv Date: 2021-12-17 Impact factor: 7.514