Key result
Primary PCI for STEMI carries a ~1.5% 1-year stent thrombosis risk with time-varying predictors.
Why the study?
The risk and predictive factors of stent thrombosis in patients with STEMI treated with primary PCI in contemporary practice were not well known.
RCT (n=10,064)
In contemporary practice, stent thrombosis remains a frequent complication of primary PCI for STEMI (1.5% at 1 year), with distinct predictors for early versus late occurrences.
Stent thrombosis risk after primary PCI for STEMI warrants ongoing clinical vigilance; observational data leave open timing-specific prevention strategies.
The aim was to know the risk and predictive factors of stent thrombosis (ST) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) in the contemporary practice. The TOTAL [ThrOmbecTomy with percutaneous coronary intervention (PCI) versus PCI ALone] randomized trial, being the largest trial performed in the setting of STEMI with a general application of the recent recommendations, represents a unique opportunity to know the current real-world incidence of ST as well as its associated factors. A total of 10 064 patients that received ≥1 coronary stent in the TOTAL trial comprise the study population. The risk, predictive factors, and clinical implications of ST was studied. During 1-year follow-up, 155 patients (1.54%) suffered definitive or probable ST (59 acute, 67 subacute, and 29 late). Previous infarction, the number of stents, the previous use of clopidogrel, and the use of diuretics at discharge were independent predictors for ST, whereas the use of upfront glycoprotein IIb/IIIa inhibitors, radial access, and treatment with statins at discharge were independent protective factors. The number of stents, stent diameter, upfront treatment with IIb/IIIa inhibitors, previous treatment with clopidogrel, and treatment with statins at discharge were independently associated with the risk of early ST. Only previous infarction was associated with the risk of late ST. In the contemporary practice, ST still constitutes a frequent complication of primary PCI for STEMI, occurring in 1.5% of patients. Independent predictors are different depending on the time of ST.
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Moreno et al. (2024) conducted an RCT in ST-elevation myocardial infarction (STEMI) (n=10,064). Primary percutaneous coronary intervention (PCI) with stenting was evaluated on Definitive or probable stent thrombosis (ST). Primary percutaneous coronary intervention for STEMI was associated with a 1.54% rate of definitive or probable stent thrombosis at 1 year, with predictors varying by the timing of the event.
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