Abstract
Early stent thrombosis (EST) (≤ 30 days after stent implantation) is a relatively rare but deleterious complication of percutaneous coronary intervention (PCI). Administration of newer P2Y12 inhibitors (prasugrel and ticagrelor) combined with aspirin has been shown to reduce the incidence of sub-acute and late stent thrombosis, compared with clopidogrel. We investigated the “real life” incidence of EST in patients from a large acute coronary syndrome (ACS) national registry, where newer P2Y12 inhibitors are widely used. Patients were derived from the ACS Israeli Survey (ACSIS), conducted during 2006, 2008, 2010 and 2013. Major adverse cardiac events (MACE) at 30days were defined as all-cause death, recurrent ACS, EST and stroke.Of the 4717 ACS patients who underwent PCI and stenting, 83% received clopidogrel and 17% newer P2Y12 inhibitors. The rate of EST was similar in both groups (1.7% in the newer P2Y12 inhibitor group vs. 1.4% in the clopidogrel-treated patients, p = 0.42). Results were consistent after multivariate analysis (adjusted HR = 1.06 [p = 0.89]). MACE occurred in 6.4% in the newer P2Y12 inhibitor group compared with 9.2% in the clopidogrel group (P<0.01). However, multivariate logistic regression modeling showed that treatment with newer P2Y12 inhibitors was not significantly associated with the secondary endpoint of MACE when compared with clopidogrel therapy [OR = 1.26 95%CI (0.93–1.73), P = 0.136]. The incidence of "real life" EST at 1month is relatively low, and appears to be similar in patients who receive newer P2Y12 inhibitors as well as in those who receive clopidogrel.
Highlights
Stent thrombosis (EST) ( 30 days after stent implantation) is a rare but severe complication which could present as ST-elevation myocardial infarction (STEMI) or sudden cardiac death within the first 30 days after stent implantation [1, 2]
Patients were derived from the acute coronary syndrome (ACS) Israeli Survey (ACSIS), a nationwide survey conducted during March and April of the years 2006, 2008, 2010 and 2013 in all 25 cardiac units and cardiology wards operating in Israel
Acute and sub-acute stent thrombosis occurred in 46% vs. 56% and 54% vs. 44% with newer P2Y12 inhibitors compared with clopidogrel, respectively, p = 0.55)
Summary
Stent thrombosis (EST) ( 30 days after stent implantation) is a rare but severe complication which could present as ST-elevation myocardial infarction (STEMI) or sudden cardiac death within the first 30 days after stent implantation [1, 2]. Stent Thrombosis in the Era of New P2y12 Inhibitors stent implantation in the context of acute coronary syndrome (ACS) than in stable coronary disease, in patients with multi-vessel disease and in those presenting with a Killip class of !2 [1,2,3,4]. This observation can be explained by platelet activation and a heightening of the coagulation process as part of the pathogenesis of ACS [5, 6]. We decided to investigate the trend and incidence of EST in a large national ACS registry in a “real life” setting, where the administration of antiplatelet drugs prior to PCI is standard care, incorporating third generation drug-eluting stents and newer P2Y12 inhibitors (prasugrel and ticagrelor)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
