title: Differential 1-year clinical outcomes for ST-segment elevation myocardial infarction related to stent thrombosis or saphenous vein graft thrombosis.
abstract: OBJECTIVE
  Thrombosis of stents and of saphenous vein grafts (SVG) remains a severe complication of either revascularization techniques that often are present as ST elevation myocardial infarction (STEMI). The aim of this longitudinal cohort study was to compare the 1-year clinical outcomes among STEMI patients requiring primary PCI due to stent thrombosis and graft occlusion presenting with STEMI.
  
  
  RESULTS
  We prospectively collected data on all patients undergoing primary PCI at the Montreal Heart Institute between April 1, 2007 and March 30, 2008. Study patients were grouped according to the etiology of the STEMI: stent thrombosis, graft thrombosis, or atherosclerosis-related STEMIs (control group). The primary combined end-point, major adverse cardiac events (MACE), was defined as death, myocardial infarction, and target vessel revascularization within 12 months as primary end point. Of the 489 STEMI patients included in the study, 23 were due to stent thrombosis, 22 to graft thrombosis, and 444 in the control group. Stent and graft thromboses were associated with a higher MACE rates, 26.1 and 22.7%, respectively, compared to the control group, 9.3% (P = 0.004). Moreover, only stent thrombosis was associated with an increased risk of MACE (HR 2.57, confidence interval 95% 1.08-6.08.
  
  
  CONCLUSIONS
  Patients with stent thrombosis present with higher rate of reinfarction while graft thrombosis is associated with an increase in 1-year cardiac mortality. Using multivariate analysis, higher MACE rates were associated with stent thrombosis as compared to graft thrombosis.
authors.affiliation: Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Qc H1T 1C8, Canada.
authors.forename: Dabit
authors.initials: D
authors.lastname: Arzamendi
authors.forename: Hung Q
authors.initials: HQ
authors.lastname: Ly
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Tanguay
authors.forename: Sebastien
authors.initials: S
authors.lastname: Armero
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Richard
authors.initials: R
authors.lastname: Gallo
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.forename: Philippe
authors.initials: P
authors.lastname: L'Allier
authors.forename: Lucie
authors.initials: L
authors.lastname: Blondeau
authors.forename: Gilbert
authors.initials: G
authors.lastname: Gosselin
authors.forename: Jean
authors.initials: J
authors.lastname: Gregoire
authors.forename: Serge
authors.initials: S
authors.lastname: Doucet
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003328:Coronary Thrombosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011792:Quebec; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D012501:Saphenous Vein / Q000503:physiopathology / Q000637:transplantation*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy