Incidence, Predictors and Clinical Outcomes of Stent Thrombosis Following PCI

Abstract

Background: Stent thrombosis is an uncommon but serious complication of percutaneous coronary intervention (PCI). The reported rate of definite stent thrombosis with new generation drug-eluting stents ranges from 0.5 to 1%. We aimed to examine the incidence and outcomes of stent thrombosis in a real-world setting. Methods: The Victorian Cardiac Outcomes Registry was established in 2013 as a state-wide clinical quality registry, with all PCI capable centres contributing in 2017. Data were collected on 41,137 consecutive PCI procedures from 2013 to 2017. We described the patient characteristics and clinical outcomes in definite and probable stent thrombosis at 30 days. Results: Stent thrombosis occurred in 225 patients (0.55%). These patients were more likely to be female (32.0% vs. 23.4%, p = 0.002) and have a history of diabetes (28.6% vs. 21.9%, p = 0.016). Stent thrombosis was more common in patients with severely reduced left ventricular ejection fraction (14.9% vs. 4.6%, p < 0.001) and in patients presenting with ST-elevation myocardial infarction, cardiogenic shock and cardiac arrest for their index PCI (all p < 0.001). Dual antiplatelet therapy at 30 days was less frequent in patients with stent thrombosis (84.8% vs. 92.0%, p < 0.001), while 30-day mortality was more common: 23.6% versus 2.0% (p < 0.001). Conclusions: Even with contemporary stents and adjunctive medications, ST still occurs following one in 200 PCIs, and is associated with significantly increased mortality at 30 days.