What is the clinical evidence from this study?

Study design: Observational. Population: Adult patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention who developed early stent thrombosis (≤30 days) or matched controls without stent thrombosis (n=240). Intervention: Repeat PCI for early stent thrombosis vs. Control group of matched primary PCI patients without stent thrombosis. Primary outcome: In-hospital mortality among patients with early stent thrombosis vs controls (OR 1.50, 95% CI 0.17-12.8, p=0.73).

What does this research mean for the field?

In patients undergoing primary PCI for STEMI in a resource-limited setting, early stent thrombosis is associated with substantial in-hospital morbidity, such as heart failure and recurrent ischemia, and is primarily managed with repeat PCI. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to assess clinical and procedural factors related to stent thrombosis after PCI and compare outcomes with controls.

March 6, 2026Cureus0 citationsOpen Access

Clinical and Procedural Characteristics and In-Hospital Outcomes of Stent Thrombosis Following Primary Percutaneous Coronary Intervention (PCI)

MHMudasir HabibGovernment Medical College MPMuzdalfa ParvezKohat University of Science and Technology KHKiflain HassanKohat University of Science and Technology

Key Result

Repeat PCI managed 77.5% of early stent thrombosis cases, with in-hospital mortality of 7.5% and substantial morbidity such as heart failure (22.5%) and recurrent ischemia (12.5%) in patients undergoing primary PCI for STEMI in Pakistan.

Key Points

The study aims to assess clinical and procedural factors related to stent thrombosis after PCI and compare outcomes with controls.
Retrospective observational study design
Involved patients underwent primary PCI and experienced early stent thrombosis
Data collected from medical records and laboratory reports
Statistical analysis conducted using SPSS software to compare cases with matched controls
80 patients with early stent thrombosis analyzed alongside 160 matched controls
Majority of patients were men with common risk factors like diabetes and hypertension
Repeat PCI was used in 77.5% of cases
In-hospital complications included heart failure in 22.5% and recurrent ischemia in 12.5%
Factors linked to stent thrombosis included high thrombus burden and reduced TIMI flow

Study Design

Type

Observational (n=240)

Multicenter

Structured PICO

Do suboptimal procedural factors (such as stent under-expansion and reduced TIMI flow) increase the risk of early stent thrombosis in adult patients undergoing primary PCI for STEMI?

Population

240 adult patients who underwent first-time primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI), including 80 cases who developed early stent thrombosis (≤30 days) and 160 matched controls without stent thrombosis. Mean age 58, 77.5% male, based in a single tertiary care center in Peshawar, Pakistan.

Intervention

Procedural factors and clinical characteristics associated with the development of early stent thrombosis (acute ≤24 hours or subacute 24 hours to 30 days) following primary PCI.

Comparator

Matched control patients (2:1 ratio) who underwent primary PCI for STEMI but did not develop stent thrombosis during the same hospitalization.

Outcome

Clinical characteristics, procedural predictors of early stent thrombosis, and in-hospital outcomes (including recurrent ischemia, heart failure, arrhythmias, bleeding events, acute kidney injury, and mortality).safety

Early stent thrombosis after primary PCI is associated with significant in-hospital morbidity and is predicted by procedural factors like stent under-expansion and reduced final TIMI flow, while post-dilatation and GP IIb/IIIa inhibitors appear protective.

Main Result

Effect estimate: OR 1.50 (95% CI 0.17-12.8)

p-value: p=0.73

Limitations

Modest sample size with only 80 early stent thrombosis cases limiting statistical power
Single-center retrospective design limits generalizability and potential for residual confounding
Low female representation (7.5%) limiting sex-specific analyses
Long-term outcomes beyond hospital discharge not assessed

Abstract

Introduction Early stent thrombosis (ST) (≤30 days) following primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains a rare but serious complication. Despite advances in stent technology and antithrombotic therapy, this condition continues to be associated with high morbidity and mortality, particularly in resource-limited settings where local data are scarce. Purpose The purpose of this study is to evaluate the clinical characteristics, procedural factors, and in-hospital outcomes of patients with early stent thrombosis and to compare these findings with matched controls without stent thrombosis in a tertiary care cardiac center in Peshawar, Pakistan. Materials and methods This retrospective observational study included adult patients undergoing primary PCI who developed acute stent thrombosis (AST) (≤24 hours) or subacute stent thrombosis (24 hours to 30 days) during the same hospitalization. Data were collected from medical records, catheterization laboratory reports, and electronic hospital systems using a structured questionnaire. SPSS version 27.0 (IBM Corp., Armonk, NY) was used for statistical analysis, with comparisons made between cases and matched controls. Results A total of 80 patients with early stent thrombosis and 160 matched controls were analyzed. The majority were men (62/80, 77.5%). Common baseline cardiovascular risk factors included diabetes mellitus (28/80, 35%), hypertension (42/80, 52.5%), dyslipidemia (34/80, 42.5%), smoking (26/80, 32.5%), and prior coronary artery disease (12/80, 15%). Acute stent thrombosis occurred predominantly within 24 hours post-PCI (16/80, 20%). Procedural characteristics, including stent type, vascular access, and adjunctive therapies, were largely similar between sexes. Repeat PCI was the primary management strategy (62/80, 77.5%), and while most patients survived to discharge, a subset experienced serious in-hospital complications: heart failure (18/80, 22.5%), recurrent ischemia (10/80, 12.5%), arrhythmias (12/80, 15%), acute kidney injury (8/80, 10%), or bleeding events (6/80, 7.5%). Procedural factors associated with early stent thrombosis included high thrombus burden, suboptimal stent expansion, overlapping stents, and reduced post-procedural thrombolysis in myocardial infarction (TIMI) flow. Conclusion Early stent thrombosis after primary PCI remains an uncommon but potentially life-threatening complication with substantial in-hospital morbidity. Timely recognition and prompt intervention, primarily through repeat PCI, are essential to improve outcomes. These findings highlight the need for larger, multicenter studies to identify modifiable patient- and procedure-related risk factors, particularly in local populations, to enhance prevention and management strategies for early stent thrombosis.

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