Key result
Stent thrombosis linked to ~6.8-fold higher odds of unsuccessful reperfusion vs de novo thrombosis.
Why the study?
There are limited data for procedural and mid-term outcomes of patients with stent thrombosis presenting with STEMI.
Does stent thrombosis as the cause of STEMI reduce the likelihood of successful angiographic reperfusion compared to de novo coronary thrombosis?
Cohort (n=190)
Does stent thrombosis as the cause of STEMI reduce the likelihood of successful angiographic reperfusion compared to de novo coronary thrombosis?
Odds Ratio: 6.8
p-value: p=0.004
Stent thrombosis in the setting of STEMI is associated with significantly poorer angiographic reperfusion compared to de novo coronary thrombosis, highlighting the need for improved interventional management.
OBJECTIVES: The aim of this retrospective study was to compare clinical and angiographic outcomes between patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) and de novo coronary thrombosis. BACKGROUND: There are limited data for procedural and mid-term outcomes of patients with ST presenting with STEMI. METHODS: From January 2004 to March 2007, 115 definite ST patients were observed: 92 (80%) of them presented as STEMI and were compared with a consecutive group of 98 patients with de novo STEMI. All patients underwent primary percutaneous coronary intervention. Primary end points were successful angiographic reperfusion and distal embolization. Major adverse cardiovascular and cerebrovascular events (MACCE), evaluated at 6-month follow-up, were defined as death, nonfatal myocardial reinfarction, target vessel revascularization, and cerebrovascular accident. RESULTS: Successful reperfusion rate was lower in patients with ST (p < 0.0001), whereas distal embolization rate was higher (p = 0.01) in comparison with patients with de novo STEMI. Stent thrombosis proved to be an independent predictor of unsuccessful reperfusion at propensity-adjusted binary logistic regression (odds ratio 6.8, p = 0.004). In-hospital MACCE rate was higher in patients with ST (p = 0.003), whereas no differences were observed at 6-month follow-up among hospital survivors between the 2 groups (p = 0.7). CONCLUSIONS: Stent thrombosis identifies a subgroup of patients with STEMI with poor angiographic and early clinical outcomes, suggesting that the management of these patients should be improved.
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Chechi et al. (2008) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=190). Stent thrombosis vs. De novo coronary thrombosis was evaluated on Unsuccessful angiographic reperfusion (OR 6.8, p=0.004). Stent thrombosis was an independent predictor of unsuccessful angiographic reperfusion compared to de novo coronary thrombosis (OR 6.8, p=0.004).
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