Key result
Renal insufficiency is linked to ~314% greater stent thrombosis risk in ACS patients.
Why the study?
Stent thrombosis is more common in acute coronary syndromes compared to stable coronary artery disease, prompting an analysis of patient- and operator-related risk factors.
Cohort (n=1,738)
No
Odds Ratio: 4.14 (95% CI 1.73–9.88)
p-value: p=<0.001
Stent thrombosis occurs in approximately 1.6% of ACS patients undergoing PCI and is strongly associated with a combination of clinical factors (like renal insufficiency and diabetes) and lesion/operator factors.
May guide risk stratification for stent thrombosis in ACS PCI patients; hypothesis-generating and should not yet change practice.
OBJECTIVE: Stent thrombosis (ST) is a common phenomenon in acute coronary syndromes (ACS) when compared to stable coronary artery disease. This study analyzed the patient- and operator-related risk factors of ST in ACS. METHODS: Coronary angiograms of 1738 consecutive ACS patients admitted in a large tertiary center between year 2014 and 2016 were analyzed retrospectively for the presence of ST. The paired angiograms [ST in ACS during and after percutaneous coronary intervention (PCI)] of the patients were analyzed by two independent observers, with focus on lesion characteristics and procedure techniques. Clinical and laboratory data were collected. RESULTS: Stent thrombosis was found in 29 (1.6%) ACS patients, with a combination of at least one clinical/laboratory risk factor and one lesion/operator risk factor identified in 28 (96%) out of the 29 ACS patients with ST. The following risk factors for ST were found: Renal insufficiency (OR=4.14, p<0.001, 95% CI=1.73-9.88), type 2 diabetes (OR=2.21, p=0.034, 95% CI=1.06-4.61), excessive alcohol consumption (OR=3.12, p=0.023, 95% CI=1.17-8.33), stent implantation for ST-elevation myocardial infarction (STEMI) (OR=2.28, p=0.029, 95% CI=1.08-4.81), left main (LM) or left anterior descending artery (LAD) as culprit lesion (OR=2.80, p=0.010, CI 95%=1.27-5.95), and absence of antiplatelet therapy prior to ST (OR=3.58, p=0.002, 95% CI=1.60-7.96). The following lesion/operator possible risk factors were identified: Bifurcation lesion (n=7; 24%), heavy coronary calcifications (n=13; 44%), in-stent restenosis with secondary plate rupture (n=6, 20%), inappropriate stent size selection (n=6, 20%), and errors in periprocedural drug administration (n=4, 14%). CONCLUSION: ST occurred in 1/62 ACS patients after PCI. A combination of clinical/laboratory and lesion/operator risk factors were present in almost all ACS patients with ST. This finding may support the search for strictly individualized strategies for the treatment of ACS patients with ST after PCI.
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M Kamenik (2020) conducted a cohort in Acute coronary syndromes (ACS) (n=1,738). Clinical and procedural risk factors (e.g., renal insufficiency) vs. Absence of risk factors was evaluated on Stent thrombosis (OR 4.14, 95% CI 1.73-9.88, p=<0.001). Renal insufficiency (OR 4.14, 95% CI 1.73-9.88) and absence of prior antiplatelet therapy (OR 3.58, 95% CI 1.60-7.96) were strongly associated with stent thrombosis in ACS patients.
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