Primary percutaneous coronary intervention for acute coronary syndrome due to stent thrombosis

Abstract

Stent thrombosis (ST) is complication of stent implantation and there are very few scientific data about the effectiveness and long-term outcomes of primary percutaneous coronary intervention (PPCI) in patients (pts) with acute coronary syndrome (ACS) due to ST. We sought to investigate efficacy of PPCI and prognosis of pts with ST presenting as ACS in single high-volume center. In 6534 consecutive pts treated with PPCI for ACS in our center, from 2006-2013., we identified 145 (2.2%) pts with ACS caused by ST. Study population consisted predominately of male pts 97 (66.9%), with mean age of 60.6 (34-93) years. Median time of ST occurrence was 6 days after stenting (range 0-4015), with acute ST in 23 (15.8%) pts, subacute in 77 (53.2%), late in 13 (8.9%) and very-late ST in 32 (22.1%) pts. Most ST occurred in stents implanted during previous PPCI for ST-segment elevation myocardial infarction (STEMI) 112 (77.2%) pts, with 33 (22.8%) pts having previous drug eluting stent, 102 (70.3%) bare-metal stent implantation, while for 10 (6.9%) pts type of previous stent was unknown. ST presented clinically as a new STEMI in 130 (89.6%) pts, in 15 (10.4%) as non-STEMI, and LAD was the predominant culprit artery in 76 pts (52.4%). Thrombus aspiration was performed in 24 (16.5%), balloon angioplasty (BA) only in 60 (41.4%) and additional stenting after BA was performed in 67 (46.2%), with overall procedure successes in 135 (93.1%) pts. GP IIb/IIIa were used in 77 (53.1%) pts and 4 (2.7%) pts received bailout intracoronary administration of thrombolytic. Distribution of In-hospital and long-term MACE, with mean duration of FU of 25.8 months (range 1-76 months), available for 96.5% of pts is presented (Table 1.): View this table: Table 1. In-hospital and long-term MACE Stent thrombosis occurs most frequently in stents previously implanted during primary PCI procedures and presents mainly as new STEMI. Patients with ST have a high rate of MACE during in-hospital stay, as well as during long-term follow-up.