Incidence, predictors and outcomes of subacute stent thrombosis following primary stenting for ST-elevation myocardial infarction.
OBJECTIVE
Knowledge concerning subacute stent thrombosis (SST) following primary stenting for ST-elevation myocardial infarction (STEMI) is not widely available. We studied the incidence, predictors, and clinical outcomes of SST following STEMI.


METHODS
We analyzed data from 455 consecutive patients who underwent primary stenting for STEMI. Baseline clinical characteristics, coronary angiographic features, medication and outcome were compared in patients with and without SST.


RESULTS
SST occurred in 17 patients, and the incidence was 3.7%. Univariate predictors of SST were being a current smoker (53.0%vs. 82.4%, p = 0.01), Killip class >or= II (38.4%vs. 58.8%, p = 0.05), no coronary re-flow after stenting (6.2%vs. 17.6%, p = 0.05) and lack of coprescription with a statin (39.5%vs. 5.9%, p<0.01). After multivariate analysis, being a current smoker (odds ratio = 4.76; 95% confidence interval 1.20-18.95) and using statin therapy (odds ratio = 0.09; 95% confidence interval = 0.01-0.75) were independent correlates of SST. Patients with SST were associated with higher 30-day mortality (37.5%vs. 3.1%, p<0.01) and all-cause mortality (23.5%vs. 5.3%, p = 0.01) at long-term follow-up.


CONCLUSIONS
Although SST is rare in patients with STEMI treated by primary stenting, it imparts a significantly higher mortality at short-term and long-term follow-up. Being a current smoker and the lack of co-prescription with a statin were associated with higher incidence of SST. Our results suggest initiation of statin therapy in patients with STEMI should be considered before discharge.
Chua
Su-Kiat
SK
Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Hung
Huei-Fong
HF
Cheng
Jun-Jack
JJ
Wang
Jen-Hsiang
JH
Lo
Huey-Ming
HM
Kuan
Peiliang
P
Lee
Shih-Huang
SH
Lin
Sheng-Chang
SC
Liou
Jer-Young
JY
Chang
Che-Ming
CM
Chiu
Chiung-Zuan
CZ
Shyu
Kou-Ci
KC
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D017023:Coronary Angiography; D005260:Female; D006331:Heart Diseases; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors