[Analysis of acute myocardial infarction one month after stent implantation].
OBJECTIVE
To study the possible causes of ST-elevated acute myocardial infarction (STEAMI) occurring one month after percutaneous coronary intervention (PCI).


METHODS
One hundred and ninety two patients aged from 40 - 79 years who had a successful previous PCI and also received primary PCI due to STEAMI in this hospitalization were included in this study. The AMI-related lesions and previous angiographic findings such as the number of lesions, the degree of the stenosis, the type of stents and the acute results of last PCI, etc. were recorded in detail. If the AMI-related lesion was localized in-stents or at the edge of stents (distance from the edge < or = 5 mm), it was defined as late thrombosis, otherwise it was regarded as an AMI induced by new-lesion.


RESULTS
New lesions, as the cause of STEAMI, were found in 144 cases (Group A, 75%), and late thrombosis in 48 patients (Group B, 25%). There was a significant difference in the average time from previous PCI to AMI (30.1 +/- 12.4 vs. 20.3 +/- 11.9 months) between the two groups. Diabetes mellitus (DM) and drug-eluting stents (DES) utilization were associated with markedly higher morbidity of late thrombosis in adjusted logistic regression analysis [hazard ratio (HR) 3.387, 95% CI 1.053 - 10.898 and HR 5.311, 95%CI 1.066 - 26.464].


CONCLUSIONS
STEAMI occurred 1 month after PCI are more likely to be developed from previous insignificant lesions than from late thrombosis in stents. Moreover, DM and DES are associated with a high incidence of late thrombosis, which may indicate that intensive antiplatelet therapy should be considered in diabetic patients receiving PCI.
Song
Guang-yuan
GY
Center of Coronary Heart Disease, Cardiovascular Institute & Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China.
Gao
Li-jian
LJ
Yang
Yue-jin
YJ
Xu
Bo
B
Gao
Run-lin
RL
Li
Jian-jun
JJ
Qiao
Shu-bin
SB
Qin
Xue-wen
XW
Liu
Hai-bo
HB
Yao
Min
M
Yuan
Jin-qing
JQ
Dai
Jun
J
You
Shi-jie
SJ
Pei
Han-jun
HJ
Zhao
Zhen-yan
ZY
Wang
Xi-mei
XM
Wu
Yong-jian
YJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000628:therapy*; D012008:Recurrence