Temporal patterns, characteristics, and predictors of clinical outcomes in patients undergoing percutaneous coronary intervention for stent thrombosis.

Mohamed, Mohamed O.; Sirker, Alex; Chieffo, Alaide; Avanzas, Pablo; Nolan, James; Rashid, Muhammad; Dafaalla, Mohamed; Moledina, Saadiq; Ludman, Peter; Kinnaird, Tim; Mamas, Mamas

Abstract

BACKGROUND: There are limited data on the outcomes of percutaneous coronary intervention (PCI) following stent thrombosis (ST) and differences exist based on timing. AIMS: Our aim was to study the rates of PCI procedures for an ST indication among all patients admitted for PCI at a national level and to compare their characteristics and procedural outcomes based on ST timing.

METHODS: All PCI procedures in England and Wales (2014-2020) were retrospectively analysed and stratified by the presence of ST into four groups: non-ST, early ST (0-30 days), late ST (>30-360 days), very late ST (>360 days). Multivariable logistic regression models were performed to assess the odds ratios (OR) of in-hospital MACCE (major adverse cardiovascular and cerebrovascular events, a composite of mortality, acute stroke and reinfarction) and mortality.

RESULTS: Overall, 7,923 (1.4%) procedures were for ST indication, most commonly for early ST (n=4,171; 52.6%), followed by very late ST (n=2,801; 35.4%) and late ST (n=951; 12.0%). The rate of PCI for ST declined between 2014 and 2020 (1.7 to 1.4%; p<0.001). Early ST was the only subgroup associated with increased odds of MACCE (OR 1.22, 95% CI: 1.05-1.41), all-cause mortality (OR 1.21, 95% CI: 1.07-1.36) and reinfarction (OR 2.48, 95% CI: 1.48-4.14), compared with non-ST indication. The odds of mortality were significantly reduced in ST patients with the use of intravascular imaging (OR 0.66, 95% CI: 0.48-0.92) and newer P2Y12 inhibitors (ticagrelor: OR 0.69, 95% CI: 0.49-0.95; prasugrel: OR 0.54, 95% CI: 0.30-0.96).

CONCLUSIONS: PCI for ST has declined in frequency over a 7-year period, with most procedures performed for early ST. Among the different times of ST onset, only early ST is associated with worse clinical outcomes after PCI. Routine use of intravascular imaging and newer P2Y12 inhibitors could further improve outcomes in this high-risk procedural group.

Citation

Mohamed, M. O., Sirker, A., Chieffo, A., Avanzas, P., Nolan, J., Rashid, M., …Mamas, M. (2022). Temporal patterns, characteristics, and predictors of clinical outcomes in patients undergoing percutaneous coronary intervention for stent thrombosis. EuroIntervention, 18(9), https://doi.org/10.4244/EIJ-D-22-00049

• Journal Article Type: Article
• Acceptance Date: May 23, 2022
• Publication Date: May 23, 2022
• Publicly Available Date: Nov 24, 2023
• Journal: EuroIntervention
• Print ISSN: 1774-024X
• Publisher: EuroPCR
• Peer Reviewed: Peer Reviewed
• Volume: 18
• Issue: 9
• DOI: https://doi.org/10.4244/EIJ-D-22-00049
• Keywords: clinical research; prior PCI; stent thrombosis
• Publisher URL: https://eurointervention.pcronline.com/article/temporal-patterns-characteristics-and-predictors-of-clinical-outcomes-in-patients-undergoing-percutaneous-coronary-intervention-for-stent-thrombosis