Predictors and implications of stent thrombosis in non-ST-segment elevation acute coronary syndromes: the ACUITY Trial.
BACKGROUND
The frequency, predictors, and consequences of stent thrombosis (ST) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) have been incompletely studied. We sought to investigate the incidence, predictors, and clinical implications of ST occurring within 1 year after percutaneous coronary intervention in patients with NSTE-ACS.


RESULTS
The Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial was a large-scale, prospective, randomized trial of antithrombotic regimens in patients with NSTE-ACS. The present analysis includes 7162 patients in whom stents were implanted. At 1 year, definite/probable ST occurred in 146 patients (2.2%), including 94 definite and 52 probable events. There were 100 episodes (1.4%) of early ST (within the first 30 days) and 46 episodes (0.8%) of late ST (between 30 days and 1 year). The incidence of ST within 1 year was similar in patients treated with drug-eluting stents or bare metal stents (hazard ratio, 0.86; 95% confidence interval, 0.62-1.20; P=0.38) and was independent of procedural antithrombotic treatment. Patients with ST compared with those without ST had strikingly higher 1-year rates of cardiac mortality (32.4% versus 2.9%, P<0.0001), myocardial infarction (82.6% versus 7.6%, P<0.0001), and target vessel revascularization (79.6% versus 7.4%, P<0.0001). Independent predictors of 1-year definite/probable ST were insulin-treated diabetes mellitus, number of diseased vessels, and ST-segment deviation ≥1 mm.


CONCLUSIONS
Compared with elective stent implantation, ST occurs with increased frequency in the first year after stent implantation in patients with NSTE-ACS, especially within the first 30 days, and is associated with marked increases in cardiac mortality and adverse events. Insulin-treated diabetes, number of diseased vessels, and dynamic ST-segment changes were independent predictors of 1-year ST in NSTE-ACS.
Istituto Cardiologia, Policlinico S Orsola, Bologna, Italy.
Tullio
T
Palmerini
George
G
Dangas
Roxana
R
Mehran
Adriano
A
Caixeta
Philippe
P
Généreux
Martin P
MP
Fahy
Ke
K
Xu
Ecaterina
E
Cristea
Alexandra J
AJ
Lansky
Gregg W
GW
Stone
D054058:Acute Coronary Syndrome / Q000473:pathology / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D003328:Coronary Thrombosis / Q000453:epidemiology* / Q000517:prevention & control; D003331:Coronary Vessels / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*
D005343:Fibrinolytic Agents; D008670:Metals