Clinical outcomes after percutaneous coronary intervention for early versus late and very late stent thrombosis: a systematic review and meta-analysis

Yi-Xing Yang,Chang-Ping Li,Xiao-Wei Li,Jing Gao,Yin Liu,Jiao Wang,Peng-Ju Lu

doi:10.1007/s11239-020-02184-7

Yi-Xing Yang, Chang-Ping Li + Show 5 more

Open Access

https://doi.org/10.1007/s11239-020-02184-7

Copy DOI

Abstract

Whether the clinical outcomes of stent thrombosis (ST) are different when stratified by time of occurrence remains unclear. The objective of this study was to compare the short- and long-term clinical outcomes after percutaneous coronary intervention (PCI) for early stent thrombosis (EST) versus late stent thrombosis (LST) and very late stent thrombosis (VLST). We enrolled eligible studies searched from the main electronic databases (EMBASE, PubMed, Cochrane). The primary endpoints were in-hospital, 30-day, 1-year and long-term mortality. The secondary endpoints included recurrent stent thrombosis (RST) and target vessel/lesion revascularization (TVR/TLR) during hospitalization, at 30 days, at 1 year and at long-term follow-up. A total of 23 studies with 17,592 patients were included. Compared with mortality rates of the late and very late thrombosis (LST/VLST) group, in-hospital (P = 0.004), 30-day (P < 0.00001), 1-year (P < 0.00001) and long-term mortality rates (P = 0.04) were significantly higher in the EST group. The in-hospital TVR/TLR rates were similar between the EST group and the LST/VLST group. However, a higher trend in TVR/TLR rate at 30 days and a significantly higher TVR/TLR rate at 1 year (P = 0.002) as well as at long-term follow up (P = 0.009) were found in the EST group. EST patients also trended toward higher risk of RST in both short- and long-term follow-up than LST/VLST patients, although differences were not statistically significant. After PCI treatment, patients with EST have worse clinical outcomes in both short- and long-term follow-up than patients with LST/VLST. Further studies are warranted to determine the optimal treatment strategies for EST.

Highlights

Stent thrombosis (ST) is a rare but catastrophic complication of percutaneous coronary intervention (PCI) with high mortality in both short-term and long-term periods [1, 2]
The results showed that patients with early stent thrombosis (EST) had a trend toward higher risk of recurrent stent thrombosis (RST) during hospitalization (3.8% vs. 2.4%, P = 0.39, Fig. 4a), at 30 days (7.2% vs. 3.4%, P = 0.33, Fig. 4b), at 1 year (9.1% vs. 5.7%, P = 0.20, Fig. 4c) and at long-term follow-up (7.6% vs. 4.7%, P = 0.05, Fig. 4d), differences were not statistically significant
One study including 152 patients reported the incidence of cardiac death (CD) at 1 year and at long-term follow-up, which were both numerically higher in the EST group than in the late stent thrombosis (LST)/very late stent thrombosis (VLST) group (1-year: 23.6% vs. 11.3%, P = 0.05; long-term: 25.5% vs. 18.6%, P = 0.31)

Summary

Introduction

Stent thrombosis (ST) is a rare but catastrophic complication of PCI with high mortality in both short-term and long-term periods [1, 2]. According to the Academic Research Consortium criteria, ST can be stratified into early stent thrombosis. Clinical outcomes after percutaneous coronary intervention for early versus late and very. (EST), occurring within 30 days after index PCI, late stent thrombosis (LST), occurring from 30 days to 1 year after index PCI, and very late stent thrombosis (VLST), occurring more than 1 year after index PCI [3].

Objectives

Results

Conclusion