Incidence and predictors of outcomes after a first definite coronary stent thrombosis.

Tovar Forero, Maria N; Zanchin, Thomas; Masdjedi, Kaneshka; van Zandvoort, Laurens J C; Kardys, Isabella; Zijlstra, Felix; Häner, Jonas; Windecker, Stephan; Van Mieghem, Nicolas M; Räber, Lorenz; Daemen, Joost (2020). Incidence and predictors of outcomes after a first definite coronary stent thrombosis. EuroIntervention, 16(4), e344-e350. Europa Digital & Publishing 10.4244/EIJ-D-19-00219

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AIMS

Stent thrombosis (ST) is a rare but potentially fatal complication of coronary artery stenting. Little is known about the optimal treatment strategy at the time of a ST event. We identified the incidence and predictors of adverse cardiac events after treatment of a definite ST.

METHODS AND RESULTS

695 patients with definite ST were included between 1996 and 2017 in 2 academic medical centres. The primary endpoint was the composite of cardiac death, myocardial infarction (MI) and target vessel revascularization (TVR) (MACE). Mean age was 62.8 ± 12.1 years and 76.3% were male. ST occurred at a median of 22 days (IQR 3-551 days); 50.8% were early and 49.2% were late/very late ST. At 60 months follow-up, MACE was 43.7%, cardiac death 19.5%, MI 17.9%, TVR 24.8%, and repeat definite ST was 12.1% (10.5% in target vessel). Independent predictors of MACE were cardiogenic shock (HR 2.54; 95%CI 1.75-3.70; p<0.001), ST in LAD (HR 1.76; 95%CI 1.32-2.35; p<0.001) prior CVA/TIA (HR 1.68; 95%CI 1.08-2.62; p=0.020), peripheral vascular disease (HR 1.55; 95%CI 1.00-2.39; p=0.046), multivessel disease (HR 1.53; 95%CI 1.12-2.08; p=0.007), and final TIMI flow 2-3 (HR 0.54; 95% CI 0.34-0.85; p=0.009). No specific treatment of ST influenced MACE, however, new generation P2Y12 inhibitors reduced the risk of MI (HR 0.56; 95% CI 0.32-0.99; p=0.049).

CONCLUSIONS

The incidence of adverse events remains high after a first episode of ST. New generation P2Y12 inhibitors reduce the risk of MI. Additional stenting, GpIIb/IIIa inhibitors and thrombectomy did not improve outcomes following ST.

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