title: Contemporary analysis of incidence and outcomes of stent thrombosis presenting as ST elevation myocardial infarction in a primary percutaneous coronary intervention cohort.
abstract: There are limited data about the effectiveness of primary percutaneous coronary intervention (PPCI) for stent thrombosis treatment. We aimed to evaluate the prevalence and outcomes of PPCI in patients with ST elevation acute myocardial infarction (STEMI) due to stent thrombosis, and comparing the outcomes with patients treated for de novo coronary thrombosis. This was an observational cohort study of 2,935 patients who underwent PPCI from 2003 to 2011 with follow-up for a median of 3.0 years (interquartile range 1.2 to 4.6). The primary end point was the first major adverse cardiac event (MACE) defined as death, nonfatal myocardial infarction, stroke, or target vessel revascularization. Stent thrombosis overall accounted for 6.6% (194 of 2,935) of all STEMIs with a proportion that increased over time (3.3% in 2004 to 9.4% in 2011). A total of 34.5% were early, 30.9% late stent thrombosis, and 34.5% were very late stent thrombosis. Indications for the original intervention were elective in 27.8%, after acute coronary syndrome (non-STEMI or unstable angina) in 21.1%, and after PPCI in 51.1%. Patients with stent thrombosis had higher rates of hypertension, hypercholesterolemia, diabetes, renal dysfunction, and previous myocardial infarction or coronary artery bypass surgery compared with patients with native artery occlusion. MACE rates were higher in patients with stent thrombosis compared with patients with native artery occlusions (40.9%, 95% confidence interval [CI] 31.1 to 50.6 vs 15.1%, 95% CI 12.5 to 18.3; p <0.0001). The poor outcome of stent thrombosis was particularly associated with early and late stent thromboses. Very late stent thrombosis appears to be a relatively less serious event, with similar outcomes to native vessel thromboses (MACE very late stent thrombosis 16.5%, 95% CI 8.2 to 28.6 vs native 15.1%, 95% CI 12.5 to 18.3, p = 0.245). In conclusion, stent thrombosis accounts for an increasing proportion of STEMI and is associated with worse outcomes compared with native artery occlusion.
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London, United Kingdom; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, United Kingdom; NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom. Electronic address: dan.jones@bartsandthelondon.nhs.uk.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Jones
authors.forename: Sean
authors.initials: S
authors.lastname: Gallagher
authors.forename: Krishnaraj S
authors.initials: KS
authors.lastname: Rathod
authors.forename: Mohammed
authors.initials: M
authors.lastname: Akhtar
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Knight
authors.forename: Martin T
authors.initials: MT
authors.lastname: Rothman
authors.forename: Akhil
authors.initials: A
authors.lastname: Kapur
authors.forename: Anthony
authors.initials: A
authors.lastname: Mathur
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Jain
authors.forename: Adam D
authors.initials: AD
authors.lastname: Timmis
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Smith
authors.forename: Andrew
authors.initials: A
authors.lastname: Wragg
mesh_terms: D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate / Q000639:trends