Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden.
OBJECTIVE
This study sought to investigate the impact of thrombus burden on the clinical outcome and angiographic infarct-related artery stent thrombosis (IRA-ST) in patients routinely treated with drug-eluting stent (DES) implantation for ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
There are limited data for the safety and effectiveness of DES in STEMI.


METHODS
We retrospectively analyzed 812 consecutive patients treated with DES implantation for STEMI. Intracoronary thrombus burden was angiographically estimated and categorized as large thrombus burden (LTB), defined as thrombus burden > or =2 vessel diameters, and small thrombus burden (STB) to predict clinical outcomes. Major adverse cardiac events (MACE) were defined as death, repeat myocardial infarction, and IRA reintervention.


RESULTS
Mean duration of follow-up was 18.2 +/- 7.8 months. Large thrombus burden was an independent predictor of mortality (hazard ratio [HR] 1.76, p = 0.023) and MACE (HR 1.88, p = 0.001). The cumulative angiographic IRA-ST was 1.1% at 30 days and 3.2% at 2 years, and continued to augment beyond 2 years. It was significantly higher in the LTB compared with the STB group (8.2% vs. 1.3% at 2 years, respectively, p < 0.001). Significant independent predictors for IRA-ST were LTB (HR 8.73, p < 0.001), stent thrombosis at presentation (HR 6.24, p = 0.001), bifurcation stenting (HR 4.06, p = 0.002), age (HR 0.55, p = 0.003), and rheolytic thrombectomy (HR 0.11, p = 0.03).


CONCLUSIONS
Large thrombus burden is an independent predictor of MACE and IRA-ST in patients treated with DES for STEMI.
Sianos
Georgios
G
Erasmus Medical Center, Department of Interventional Cardiology, Thoraxcenter, Rotterdam, The Netherlands. g.sianos@erasmusmc.nl
Papafaklis
Michail I
MI
Daemen
Joost
J
Vaina
Sofia
S
van Mieghem
Carlos A
CA
van Domburg
Ron T
RT
Michalis
Lampros K
LK
Serruys
Patrick W
PW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
D007166:Immunosuppressive Agents