Patient-related factors including premature DAPT discontinuation, clopidogrel resistance, smoking, diabetes, malignancy, and reduced ejection fraction increase the risk of stent thrombosis.
What patient-related factors predict stent thrombosis in patients undergoing percutaneous coronary interventions?
Addressing modifiable patient-related factors such as smoking, diabetes, and DAPT adherence is crucial for minimizing the risk of stent thrombosis after PCI.
Over the past four decades, percutaneous coronary intervention (PCI) safety and efficacy have significantly improved, particularly with the advent of the drug-eluting stent (DES). First-generation DESs reduced in-stent restenosis rates and targeted lesion revascularization; however, safety issues emerged, due to high incidences of stent thrombosis (ST) linked to death, myocardial infarction, and repeat revascularization. Second-generation DESs were developed to overcome these issues, reducing late-thrombotic-event risk while maintaining anti-restenosis efficacy. Nevertheless, ST still occurs with second-generation DES use. Stent thrombosis etiology is multifaceted, encompassing lesion-, patient-, procedural-, and stent-related factors. Overall, most early-stent-thrombosis cases are linked to procedural and patient-related aspects. Factors like premature discontinuation of dual antiplatelet therapy, resistance to clopidogrel, smoking, diabetes mellitus, malignancy, reduced ejection fraction or undertaking coronary angioplasty for an acute coronary syndrome can increase the risk of stent thrombosis. The aim of this study is to assess patient-related factors that potentially heighten the risk of stent thrombosis, with the objective of pinpointing and addressing modifiable contributors to this risk. By focusing on both patient- and procedure-related factors, a multifaceted approach to coronary revascularization can help minimize complications and maximize long-term benefits in managing ST.
Anghel et al. (Tue,) conducted a review in Stent thrombosis in percutaneous coronary interventions. Patient-related risk factors was evaluated on Stent thrombosis. Patient-related factors including premature DAPT discontinuation, clopidogrel resistance, smoking, diabetes, malignancy, and reduced ejection fraction increase the risk of stent thrombosis.