ST-segment elevation myocardial infarction due to early and late stent thrombosis a new group of high-risk patients.
OBJECTIVE
The aim of this retrospective study was to compare clinical and angiographic outcomes between patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) and de novo coronary thrombosis.


BACKGROUND
There are limited data for procedural and mid-term outcomes of patients with ST presenting with STEMI.


METHODS
From January 2004 to March 2007, 115 definite ST patients were observed: 92 (80%) of them presented as STEMI and were compared with a consecutive group of 98 patients with de novo STEMI. All patients underwent primary percutaneous coronary intervention. Primary end points were successful angiographic reperfusion and distal embolization. Major adverse cardiovascular and cerebrovascular events (MACCE), evaluated at 6-month follow-up, were defined as death, nonfatal myocardial reinfarction, target vessel revascularization, and cerebrovascular accident.


RESULTS
Successful reperfusion rate was lower in patients with ST (p < 0.0001), whereas distal embolization rate was higher (p = 0.01) in comparison with patients with de novo STEMI. Stent thrombosis proved to be an independent predictor of unsuccessful reperfusion at propensity-adjusted binary logistic regression (odds ratio 6.8, p = 0.004). In-hospital MACCE rate was higher in patients with ST (p = 0.003), whereas no differences were observed at 6-month follow-up among hospital survivors between the 2 groups (p = 0.7).


CONCLUSIONS
Stent thrombosis identifies a subgroup of patients with STEMI with poor angiographic and early clinical outcomes, suggesting that the management of these patients should be improved.
Cardiologia e Cardiologia Invasiva 2, A.O.U. Careggi, Florence, Italy.
Tania
T
Chechi
Sabine
S
Vecchio
Guido
G
Vittori
Gabriele
G
Giuliani
Alessio
A
Lilli
Gaia
G
Spaziani
Lorenzo
L
Consoli
Giorgio
G
Baldereschi
Giuseppe G L
GG
Biondi-Zoccai
Imad
I
Sheiban
Massimo
M
Margheri
D000368:Aged; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D015425:Myocardial Reperfusion; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome