Abstract 9153: Predictive and Protective Factors of Early, Late, and Very Late Stent Thrombosis in Acute Coronary Syndrome Patients Undergoing Coronary Stent Implantation: Findings from the Atlas Acs 2-timi 51 Trial

Abstract

Introduction: Stent thrombosis (ST) is an uncommon but serious complication of stent implantation. The aim of this analysis was to explore predictive and protective factors of early, late, and very late ST. Methods: This was a post-hoc analysis of the ATLAS ACS 2-TIMI 51 trial, which included acute coronary syndrome patients who received stent placement. Incidence of ST was assessed by Kaplan-Meier estimates at 30 days, 31 to 360 days, 361 to 720 days, and up to 720 days, with day 1 defined as the day of stent implantation. Multivariable associations with ST were explored by fitting Cox proportional hazards models. The covariates included patient characteristics, baseline laboratory tests (i.e., cardiac biomarkers, hemoglobin, platelet count, white blood cell [WBC]), and ST treatment (i.e., drug-eluting stent [DES] vs. bare-metal stent and anticoagulant with rivaroxaban vs. placebo). Results: Among 8,741 stented patients, a total of 155 ST events (2.25%) occurred by day 720. The cumulative incidence of early, late, and very late ST was 0.80%, 0.81%, and 0.77%, respectively. After multivariable adjustment, age ≥75 years (HR=2.13 [95% CI: 1.26-3.60]), a history of prior myocardial infarction (MI) (HR=1.81 [95% CI: 1.22-2.68]), low hemoglobin (HR=2.34 [95% CI: 1.59-3.44]), high WBC (HR=1.58 [95% CI: 1.02-2.46]), DES (HR=0.56 [95% CI: 0.38-0.83]), and rivaroxaban (HR=0.63 [95% CI: 0.44-0.88]) were associated with overall ST. Low hemoglobin (HR=2.35 [95% CI: 1.34-4.12]) and high WBC (HR=2.11 [95% CI: 1.17-3.81]) were predictive of early ST. Low hemoglobin (HR=2.32 [95% CI: 1.26-4.27]), prior MI (HR=2.98 [95% CI: 1.67-5.31]), and DES (HR=0.33 [95% CI: 0.16-0.67]) were associated with late ST. Age ≥75 years was predictive of very late ST (HR=3.71 [95% CI: 1.12-12.3]). Conclusions: The study identified factors with positive and negative associations with early, late, and very late ST that may be useful in constructing risk assessment models for ST.