Key result
Nonacute stent thrombosis in STEMI links to higher MACE but not mortality vs de novo lesions.
Why the study?
While acute stent thrombosis has decreased significantly, patients still face the risk of nonacute stent thrombosis over time, prompting comparison of prognosis against de novo lesions.
Does primary PCI for nonacute stent thrombosis increase mortality and MACEs compared to de novo lesions in STEMI patients?
Cohort (n=8,069)
Yes
Does primary PCI for nonacute stent thrombosis increase mortality and MACEs compared to de novo lesions in STEMI patients?
Hazard Ratio: 1.61 (95% CI 0.95–2.75)
Absolute Event Rate: 12.3% vs 6.6%
p-value: p=0.078
In STEMI patients undergoing primary PCI, nonacute stent thrombosis is associated with a higher risk of recurrent MI and MACEs at 1 and 2 years compared to de novo lesions, though mortality risk is similar.
May inform risk stratification after STEMI PCI; leaves open whether targeted interventions reduce MACE without mortality benefit.
Objectives: To compare short and long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) caused by de novo lesions or nonacute stent thrombosis treated by primary PCI.Background: The incidence of acute stent thrombosis has decreased significantly, however, with the extension of postoperative time, patients still have a possibility of developing nonacute stent thrombosis.Methods: A total of 8069 STEMI patients who undergoing primary PCI from the China Acute Myocardial Infarction Registry (CAMI) were enrolled and divided into a nonacute stent thrombosis group and a de novo lesion group according to angiographic thrombosis findings. Propensity score matching (1∶2) according to baseline risk factors was performed between the two groups. The primary outcome was the incidence of all-cause mortality in the hospital and at the 1-year and 2-year follow-ups. The secondary outcome was the incidence of all major adverse cardiovascular events (MACEs) in the hospital and at follow-ups.Results: A total of 121 STEMI patients(96 males) with nonacute stent thrombosis and 7948 STEMI patients(6473 males) with de novo lesions were enrolled. After propensity score matching, 121 patients were enrolled in the nonacute stent thrombosis group and 242 patients in the de novo lesion group. The incidences of recurrent MI (4.7% vs. 0.9%, P=0.039) and MACEs (14.8% vs. 7.4% at the 1-year follow-up, P=0.034; 18.0% vs. 9.1% at the 2-year follow-up, P=0.020) was higher in the nonacute stent thrombosis group. Multivariate Cox regression analysis showed that advanced age, female sex, history of diabetes, chronic renal insufficiency and low preoperative EF were independent risk factors for all-cause death at 2 years. Stent thrombosis was an independent risk factor for MACEs at the 1- and 2-year follow-ups but not for all-cause death.Conclusions: The nonacute stent thrombosis group had a higher incidence of recurrent MI and MACEs at follow-up than the de novo lesion group. Nonacute stent thrombosis was an independent risk factor for all MACEs, but not mortality, at the 1-year and 2-year follow-ups.Trial registration: CAMI, NCT01874691, Registered 11/06/2013, https://clinicaltrials.gov/ct2/show/NCT01874691?term=01874691&draw=2&rank=1
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Wang et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=8,069). Nonacute stent thrombosis vs. De novo lesions was evaluated on All-cause mortality at 2-year follow-up (HR 1.61, 95% CI 0.95-2.75, p=0.078). Nonacute stent thrombosis in STEMI patients was associated with a higher incidence of major adverse cardiovascular events at 2 years compared to de novo lesions, but did not significantly increase all-cause mortality.
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