Key result
Customized dual antiplatelet therapy based on patient-specific risk factors is the most effective strategy for preventing stent thrombosis following drug-eluting stent implantation.
Why the study?
Although modern drug-eluting stents have reduced stent thrombosis, the risk persists primarily in the early stage post-PCI and multiple factors contribute to its development, outcomes, and prevention.
Does customized dual antiplatelet therapy prevent stent thrombosis in patients aged 45 years and above undergoing percutaneous coronary intervention with drug-eluting stents?
Systematic Review
Does customized dual antiplatelet therapy prevent stent thrombosis in patients aged 45 years and above undergoing percutaneous coronary intervention with drug-eluting stents?
Customized dual antiplatelet therapy based on patient-specific risk factors is the most favorable strategy to prevent stent thrombosis after drug-eluting stent implantation.
Reaffirms the need for strict early antiplatelet adherence post-percutaneous coronary intervention; confirms.
Stent thrombosis (ST) is a rare but catastrophic event to happen to a stented coronary artery. The incidence of ST has greatly been reduced after the advent of modern drug-eluting stent (DES) implants, which have become the most preferred treatment option in the stenting category for coronary artery disease (CAD). Although the risk reduction by newer category implant provides substantial benefits, the possibility of thrombosis still exists mostly during the early stage of DES implantation. The development of ST after percutaneous coronary intervention (PCI) can be predicted by multiple factors, but advancements in early diagnostic techniques and modified stent types have greatly reduced the occurrence of this complication. Mortality, which is one of the complications of ST, is primarily influenced by patient-related factors such as incomplete treatment duration of dual antiplatelet therapy (DAPT). The duration of DAPT after DES implantation in patients with acute coronary syndrome (ACS) is determined based on individual characteristics, mainly considered in view of bleeding or ischemia risk. Risk evaluation systems like DAPT/precise-DAPT scores help tailor and personalize the duration of DAPT for each individual patient. This systematic review contains pertinent articles extracted from the PubMed database. We retrieved articles from various study categories, encompassing publications from the period spanning 2014 to 2022. Our analysis highlighted results from studies investigating different aspects contributing to ST development. The most favorable prevention option was the use of customized DAPT intervention based on patient-specific predictable factors. Several complications associated with ST were identified, including recurrent ST, major adverse cardiovascular events (MACE) encompassing all-cause mortality (including cardiac and non-cardiac mortality), cerebrovascular accidents (CVA) or transient ischemic attacks (TIA), hospitalization due to heart failure, and myocardial infarction requiring revascularization. Mortality was also observed as a significant outcome. The umbrella term of ST includes multiple causative factors. Although DES has improved patient survival rates vastly with its usage, careful risk factor assessment and required follow-up, in each individual being stented, further guarantee a more promising reduction in late adverse outcomes.
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Sohail et al. (2023) conducted a systematic review in Stent Thrombosis. Percutaneous coronary intervention with drug-eluting stents was evaluated on Incidence, predictors, outcomes, and prevention of stent thrombosis. Customized dual antiplatelet therapy based on patient-specific risk factors is the most effective strategy for preventing stent thrombosis following drug-eluting stent implantation.
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