Key result
Early stent thrombosis links to ~67% higher in-hospital mortality than late or very late thrombosis.
Why the study?
Whether the clinical outcomes of stent thrombosis differ when stratified by time of occurrence remains unclear.
Does early stent thrombosis result in worse clinical outcomes compared to late and very late stent thrombosis in patients undergoing percutaneous coronary intervention?
Meta-Analysis (n=17,592)
Does early stent thrombosis result in worse clinical outcomes compared to late and very late stent thrombosis in patients undergoing percutaneous coronary intervention?
Relative Risk: 1.67 (95% CI 1.17–2.37)
p-value: p=0.004
Patients presenting with early stent thrombosis have significantly higher short- and long-term mortality after PCI compared to those with late or very late stent thrombosis.
Early stent thrombosis after PCI signals higher in-hospital mortality risk; reinforces timing as a prognostic factor in stent thrombosis meta-analyses.
Whether the clinical outcomes of stent thrombosis (ST) are different when stratified by time of occurrence remains unclear. The objective of this study was to compare the short- and long-term clinical outcomes after percutaneous coronary intervention (PCI) for early stent thrombosis (EST) versus late stent thrombosis (LST) and very late stent thrombosis (VLST). We enrolled eligible studies searched from the main electronic databases (EMBASE, PubMed, Cochrane). The primary endpoints were in-hospital, 30-day, 1-year and long-term mortality. The secondary endpoints included recurrent stent thrombosis (RST) and target vessel/lesion revascularization (TVR/TLR) during hospitalization, at 30 days, at 1 year and at long-term follow-up. A total of 23 studies with 17,592 patients were included. Compared with mortality rates of the late and very late thrombosis (LST/VLST) group, in-hospital (P = 0.004), 30-day (P < 0.00001), 1-year (P < 0.00001) and long-term mortality rates (P = 0.04) were significantly higher in the EST group. The in-hospital TVR/TLR rates were similar between the EST group and the LST/VLST group. However, a higher trend in TVR/TLR rate at 30 days and a significantly higher TVR/TLR rate at 1 year (P = 0.002) as well as at long-term follow up (P = 0.009) were found in the EST group. EST patients also trended toward higher risk of RST in both short- and long-term follow-up than LST/VLST patients, although differences were not statistically significant. After PCI treatment, patients with EST have worse clinical outcomes in both short- and long-term follow-up than patients with LST/VLST. Further studies are warranted to determine the optimal treatment strategies for EST.
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Yang et al. (2020) conducted a meta-analysis in Stent thrombosis (n=17,592). Early stent thrombosis vs. Late and very late stent thrombosis was evaluated on In-hospital mortality (RR 1.67, 95% CI 1.17-2.37, p=0.004). Early stent thrombosis was associated with significantly higher in-hospital mortality (RR 1.67) compared to late and very late stent thrombosis following percutaneous coronary intervention.
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