Predictors Of Stent Thrombosis Research Articles

INTRAPROCEDURAL STENT THROMBOSIS DURING PERCUTANEOUS CORONARY INTERVENTION: HOW TO PREDICT

Background: Intraprocedural stent thrombosis (IPST) during percutaneous coronary intervention (PCI) is an uncommon event that results in a poor outcome including STEMI and sudden cardiac death. Concerns about an increased risk of stent thrombosis with drug-eluting stents (DES) continue, even though the incidence, timing, and predictors of stent thrombosis with DES have not been identified. Objective: This study aimed to describe the diagnosis and management of Intraprocedural Stent Thrombosis. Case presentation: We will discuss a 49 year-old male brought to our hospital because of chest pain while doing moderate activity. One month prior to admission, he had history of acute coronary syndrome and 1 DES on right coronary artery was placed. Ticagrelor and aspirin were routinely consumed as dual antiplatelet therapy. The patient was diagnosed with intraprocedural stent thrombosis during PCI with the evidence of intra-catheter thrombosis and ST segment elevations seen in the ECG monitor. We treat the patient with Ticagrelor 180 mg loading dose and intracoronary unfractionated heparin (UFH) during procedure continued with continuous infusion until 24 hours. No event of subsequent acute coronary syndrome was observed. Conclusion: Intraprocedural Stent Thrombosis was a strong predictor of mortality in STEMI patients. This case showed that the present widespread use of DES instead of BMS for coronary implantation although decreased the future risk of repeat revascularization, increased the risk of thrombosis. Prior risk stratification, potent early antiplatelet treatment and anticoagulant of choice with UFH might be used to reduce the risk of thrombosis in STEMI patients undergoing stent implantation.

РАННИЕ И ОТДАЛЕННЫЕ КЛИНИЧЕСКИЕ ИСХОДЫ У ПАЦИЕНТОВ С НЕСТАБИЛЬНОЙ СТЕНОКАРДИЕЙ И СТЕНТИРОВАНИЕМ КОРОНАРНЫХ АРТЕРИЙ

Aim. To study early and long-term clinical outcomes in patients with unstable angina (UA) and coronary artery stenting based on the results of a seven-year follow-up. Materials and Methods. The study included 165 patients with UA and coronary artery stenting. The average age of patients was 59.04±10.34 years; the number of male patients was 129 (78.2%). The risk by the GRACE scale was 96.9±17.46 points. The average number of affected coronary arteries was 2.23±1.07 per person, the average number of implanted stents was 2.10±1.45 per person, the average length of the stented area was 43.12±25.6 mm. Everolimus- or sirolimus-eluting stents were used. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein; platelet, plasma, and vascular hemostasis were evaluated. The patients underwent echocardiography, coronary angiography. The follow-up period was 7±1.6 years. Results. During a 7-year follow-up period, with endovascular treatment strategy and double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg repeated UA developed in 91 (55.2%) pts and myocardial infarction was registered in 21 (12.7%) pts. Cardiovascular mortality was 7.3%. Independent stent thrombosis risk predictors included AUC ADR test ≥ 77.5 U, troponin I ≥ 0.90 ng/ml, total length of the stented area ≥ 60 mm. Independent predictors of the development of restenosis/neoatherosclerosis included: more than 4 implanted stents per patient (RR 1.440; 95% CI 1.233-1.681), the total length of the stented area ≥ 60 mm (RR 1.532; 95% CI 1.245-1.884), homocysteine ≥ 14 µmol/l (RR 1.479; 95% CI 1.168-1.876), myeloperoxidase ≥ 300 pmol/l (RR 1.351; 95% CI 1.102-1.656), with risk factors including a history of coronary heart disease for more than 5 years (RR 13.011; 95% CI 4.226-40.050), diabetes mellitus (RR 1.367; 95% CI 1.136-1.647). Conclusion. The number of early and long-term coronary events in patients with unstable angina and coronary artery stenting was estimated. Predictors of stent thrombosis, restenosis and the formation of new atherosclerotic plaques outside the stenting zone were identified.

Incidence and Predictors of Stent Thrombosis in Patients Treated with Stents for Coronary Bifurcation Narrowing (From the BIFURCAT Registry)

Percutaneous coronary interventions performed at coronary bifurcations yield high rates of stent thrombosis (ST). The aim of the present study was to investigate the predictors of ST in contemporary coronary bifurcation percutaneous coronary interventions. We retrospectively investigated the BIFURCAT (comBined Insights From the Unified RAIN and COBIS bifurcAtion regisTries) registry on coronary bifurcations to assess the incidence and predictors of definite ST, which were the study primary endpoints. Predictors of ST among patients on dual antiplatelet therapy (DAPT) were also examined. A total of 5330 patients were included. After a mean 2-years follow-up, 64 (1.2%) patients experienced ST. 42 (65.6%) ST patients were on DAPT. At multivariable analysis, age (HR 1.02, CI 1.01 to 1.05, p=0,027), smoking status (HR 2.57, CI 1.49 to 4.44, p=0.001), chronic kidney disease (HR 2.26, CI 1.24 to 4.12, p=0.007) and a 2-stent strategy (HR 2.38, CI 1.37 to 4.14, p=0.002) were independent predictors of ST, whereas intracoronary imaging (HR 0.42, CI 0.23 to 0.78, p=0.006) and final kissing balloon (FKB) (HR 0.48, CI 0.29 to 0.82, p=0.007) were protective against ST. Among patients on DAPT, smoking status and a 2-stent strategy significantly increased the risk of ST, while intracoronary imaging and FKB reduced the risk. In conclusion, age, smoking status, chronic kidney disease and a 2-stent strategy were significant predictors of ST, whereas intracoronary imaging use and FKB had a protective effect. Only smoking status and a 2-stent strategy significantly predicted ST in DAPT subgroup, while intracoronary imaging and FKB had a protective role.

Mean platelet volume/platelet count ratio as a predictor of stent thrombosis in patients with ST-segment-elevation myocardial infarction.

Despite the important role of some haematological parameters in tendency to thrombosis is known, their relationship with long-term stent thrombosis (ST) remains unclear. This study aimed to investigate the association between the mean platelet volume (MPV) to platelet count (PC) ratio and long-term ST and mortality in patients with ST-segment-elevation myocardial infarction (STEMI) treated successfully by primary percutaneous coronary intervention (pPCI). In a retrospective cohort study, according to their baseline MPV/PC ratios, 3667 consecutive STEMI patients undergoing pPCI were divided into three groups: tertile 1 (T1) (n = 1222, 0.357 ≥ MPV/PC ≥ 0.043), tertile 2 (T2) (n = 1222, 0.033 < MPV/PC < 0.043) and tertile 3 (T3) (n = 1223, 0.009 ≤ MPV/PC ≤ 0.032). Patients were followed up with for 5years, focusing on ST and all-cause mortality outcomes. Patients with T1 displayed a greater 5-year ST rate, including a 2.76-fold greater (95% confidence interval 1.68-10.33) rate than that of patients with T3, who had the lowest rates and were used as the reference group. Meanwhile, the 5-year mortality rate was similarly higher among patients with T1 by 1.72 times (95% confidence interval 1.33-2.22) relative to that among patients with T3. These significant relationships persisted even after adjustment for all confounders. We found that higher MPV/PC ratios were associated with long-term ST and mortality. The MPV/PC ratio may constitute both a rapid and an easily obtainable parameter for identifying reliably high-risk patients who have undergone pPCI.

A WIN-WIN SITUATION: URGENT TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) IN A PATIENT WITH RECENT MULTIVESSEL PERCUTANEOUS CORONARY INTERVENTION (PCI) FOR A NON-CARDIAC SURGERY

Stent thrombosis(ST) is a devastating complication of PCI. Dual antiplatelet therapy (DAPT) interruption is the strongest predictor of ST, and the highest risk is in the first 6 weeks. Therefore, surgical treatments within 6 weeks of PCI is a challenging situation. A 88-year-old Caucasian female

Incidence and predictors of stent thrombosis after endovascular revascularisation of the superficial femoral artery

The aims of this study were to assess the incidence and predictors of superficial femoral artery (SFA) stent thrombosis (ST) in a large patient cohort. A total of 984 stented SFA lesions were retrospectively analysed in 717 patients. We observed an overall ST rate of 7.5% (74/984): 14% occurred early within 30 days after stenting, 51% during the first year thereafter and 35% later than one year. The estimated five-year probability of ST was 13.4% (95% confidence interval [CI]: 10.0% to 16.7%). Significant predictors of ST were stent length (hazard ratio [HR] 1.09, 95% CI: 1.06 to 1.11, p<0.001), lesion length (HR 1.10, 95% CI: 1.08 to 1.13, p<0.001), female gender (HR 1.79, 95% CI: 1.12 to 2.86, p=0.015), chronic total occlusion (CTO) (HR 4.21, 95% CI: 2.51 to 7.05, p<0.001), implantation of more than one stent (two stents: HR 6.06, 95% CI: 3.35 to 11.0, p<0.001; three or more stents: HR 16.83, 95% CI: 9.43 to 30.0, p<0.001) as well as lesion complexity criteria as expressed by TASC II C/D (HR 17.7, 95% CI: 5.56 to 56.1, p<0.001). ST after SFA stenting was a common adverse event in our cohort and peaked during the first year after stent implantation. Independent predictors of ST included lesion length and stent length, female gender, presence of CTO, number of implanted stents and lesion complexity.

Long-term outcomes after bioresorbable scaffold implantation in patients with coronary artery stenosis

Aim. The present study aimed to demonstrate the long-term outcomes after Absorb (Abbott Vascular, USA) everolimus-eluting bioresorbable vascular scaffold (BVS) implantation in real-world patients with coronary artery disease.Methods. This trial involved the largest registry of Absorb BVS implantation in patients with coronary artery disease from Russia, and it was conducted between 2014 and 2018 (n = 500). Safety and efficacy parameters (target vessel failure, defined as a composite of cardiac death, target vessel myocardial infarction and clinically driven target vessel revascularisation; major adverse cardiac and cardiovascular events, defined as a composite of cardiac death, myocardial infarction, target vessel revascularisation and stroke, stent thrombosis according to the Academic Research Consortium definition) were assessed over a period of 2 years after the index procedure. Results. Lesion treatment success was achieved in 98.51% (n = 594) of patients. In the 2 years after Absorb BVS implantation, long-term outcomes were assessed via phone calls. Only 9.8% (n = 49) of patients were lost to follow-up. The rates of target vessel failure and major adverse cardiac and cerebrovascular events were 11.6% (n = 58) and 12.6% (n = 63), respectively. Definite/probable stent thrombosis was observed in 3.2% (n = 16) of patients. Conclusion. Using an optimal implantation technique during Absorb BVS implantation in routine clinical practice leads to a high level of lesion treatment success. However, despite this, Absorb BVS use is associated with an increased risk of device-related adverse events, particularly stent thrombosis. Absorb BVS use in long and bifurcated lesions and BVS implantation in the distal segment of the coronary artery are independent predictors of stent thrombosis. In addition, Absorb BVS use in patients with a high functional class of angina and heart failure, multivessel coronary artery disease as well as BVS implantation in the distal segment of the coronary artery are independent predictors of device-related adverse events.Received 22 July 2019. Revised 1 October 2019. Accepted 14 October 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

High N-Terminal proB-Type Natriuretic Peptide Indicates Elevated Risk of Death after Percutaneous Coronary Intervention Compared to Coronary Artery Bypass Surgery in Patients with Left Ventricular Dysfunction.

Background: Reduced left ventricular function (LVF) is a predictor for stent-thrombosis. In advanced heart failure (characterized by high NT-proBNP) with an activated coagulation system, coronary events clinically perceived as sudden death or death from heart failure may be more common in patients treated by percutaneous coronary intervention (PCI) than in patients treated by coronary artery bypass grafting (CABG). Our study analyses (1) if patients with reduced LVF who require coronary revascularization will have a better survival benefit with CABG or PCI, and (2) if the survival benefit is predicted by NT-proBNP. Methods: This observational retrospective study included patients from the coronary catheter laboratory database of the Medical University of Vienna (CCLD-MUW). Multivariate Cox regression analyses were performed to test the hypothesis that there is an interaction in the risk of death between those with lower or elevated NT-proBNP levels and the revascularization procedure (PCI or CABG). The relative risk of PCI compared to CABG as reference was calculated for patients with low and elevated NT-proBNP levels. Results: In the entire study population with 398 patients (340 PCI and 58 CABG) the revascularization procedure had no predictive value. When the revascularization procedure*NTproBNP interaction was forced into the Cox regression model, this term was an independent predictor of death. The relative risk of PCI compared to CABG was similar in patients with lower NT-proBNP—1.01 (95% confidence interval (CI), 0.45–2.24), but was significantly increased in patients with elevated NT-proBNP—1.58 (95% CI, 1.07–2.33). Conclusion: Death is associated to the revascularization procedure, but only in those patients with elevated NT-proBNP levels. NT-proBNP is a predicting factor for the revascularization procedure: elevated levels showed an increased risk of death after PCI compared to CABG, whereas lower levels were associated with a similar risk after both revascularization procedures.

Stent malapposition, strut coverage and atherothrombotic prolapse after percutaneous coronary interventions in ST-segment elevation myocardial infarction.

Stent implantation in ST-segment elevation myocardial infarction (STEMI) patients can be challenging and sometimes associated with immediate and long-term suboptimal results. Stent malapposition and strut uncoverage, predictors of stent thrombosis, are frequently detected in STEMI patients at medium/long-term follow-up. Nevertheless, data at a short follow-up are missing. We aimed to assess the extent of stent malapposition and struts coverage in the subacute phase of STEMI after stent implantation in primary or rescue percutaneous coronary intervention (PCI). STEMI patients undergone primary or rescue PCI and scheduled for a second coronary angiography after 2-7 days were enrolled. During the second procedure, frequency domain optical coherence tomography (FD-OCT) was performed to assess percentage of malapposed struts (MS%), percentage area of malapposition (MA%), percentage of uncovered struts (US%), percentage area of atherothrombotic prolapse (PA%) and optical coherence tomography thrombus score (OCT-TS). Twenty patients were included and 21 stents (19 865 struts) were evaluated. Strut uncoverage was relatively limited [US% = 11.1 (8.1-13.6) %]. Stent malapposition was observed frequently, even if at low degree [MS% = 6.4 (3.3-13.3) %, MA% = 1.80 (0.46-2.76) %] as well as atherothrombotic prolapse [PA% = 0.09 (0.00-1.06) %]. Both MA% and PA% were significantly related to residual OCT-TS (R = -0.52, P = 0.02 and R = 0.71, P < 0.001, respectively), use of thrombolysis (P = 0.001 and P = 0.004, respectively) and time elapsed from PCI to FD-OCT analysis (P = 0.001). In the subacute phase after stenting in STEMI patients, strut uncoverage is relatively limited, while stent malapposition and atherothrombotic prolapse are common albeit limited features. Residual thrombus burden influences the degree of both stent malapposition and atherothrombotic prolapse.

Predictors of stent thrombosis and their implications for clinical practice

Stent thrombosis (ST) is a rare but severe complication of coronary procedures with high mortality, high relapse rate and a very complex pathophysiology. An individual's susceptibility to ST is multifactorial and results from interactions between clinical factors, endothelial biology, hypersensitivity and/or inflammatory reactions, blood rheology, platelet reactivity, clotting factors, physical and mechanical properties of the stent and from the effects of these different factors on the fluid dynamics of blood flow. Since the introduction of stents 32 years ago, continuous improvements in our understanding of the pathophysiology of ST have triggered important advances, including new therapies, new technologies and an increased awareness of the implications of implantation techniques. Furthermore, advances in medical imaging and in the mathematical processing of this information have allowed a more detailed assessment of the mechanisms of ST at the time of its onset. Evidence shows that addressing the risk factors for ST leads to a substantial reduction in its incidence, both early and late after stent implantation. A better knowledge of the mechanisms of this complication is, however, necessary to direct the choice of the most appropriate strategy for its prevention and treatment.

Način revaskularizacije miokarda i ishod kod pacijenata sa ishemijskom kardiomiopatijom i višesudovnom koronarnom bolešću

Backgroud: Several studies have compared outcome of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in the treatment of multivessel coronary disease, but a few were focused on patients with reduced left vetricular function. The aim of the study was to compare effectiveness of PCI and CABG in patients with iscaaemic cardiomyopathy and multivessel coronary disease Methods: This single-center study, included 178 patients, admitted because of symptomatic multivessel coronary disease, ejection fraction of left ventricle (EF) ≤50%, who underwent PCI or CABG, with two-years follow up of adverse cardiac and cerebrovascular events (MACCE), which included mortality, myocardial infarction (MI), target lesion/vessel revascularisation (TLR/TVR) and stroke. Results: There was higher incidence of MACCE in PCI group (18.1% vs. 9.5%, p=0.145). That was mainly because of higher incidence of MI (6% vs. 0%, p=0.021) and TLR/TVR (6% vs. 0%, p=0.021) in PCI group. There was no difference in mortality rate (9.6% in PCI group vs. 9.5% in CABG group, p>0.05). Age, fibrinogen, C-reactive protein were predictors of stent thrombosis, while left ventricular dilatation, EuroSCORE and SYNTAXscore were predictors of mortality in our study. Conclusion: There was no difference in mortality rate during 2-year follow-up after PCI and CABG in studied patients. Incidence of MI and TLR/TVR was higher after PCI comparing with CABG.

Peripheral Stent Thrombosis Leading to Acute Limb Ischemia and Major Amputation: Incidence and Risk Factors in the Aortoiliac and Femoropopliteal Arteries

PurposeTo report the real-world incidence and risk factors of stent thrombosis in the aortoiliac and femoropopliteal arteries in case of bare nitinol stent (BNS) or covered nitinol stent (CNS) placement from a single-centre retrospective audit.Materials and MethodsMedical records of consecutive patients treated with peripheral stent placement for claudication or critical limb ischemia were audited for definite stent thrombosis defined as imaging confirmed stent thrombosis that presented as acute limb-threatening ischemia. Cases were stratified between aortoiliac and femoropopliteal anatomy. Cox regression analysis was employed to adjust for baseline clinical and procedural confounders and identify predictors of stent thrombosis and major limb loss.Results256 patients (n = 277 limbs) were analysed over a 5-year period (2009–2014) including 117 aortoiliac stents (34 CNS; 12.8 ± 5.0 cm and 83 BNS; 7.8 ± 4.0 cm) and 160 femoropopliteal ones (60 CNS; 21.1 ± 11.0 cm and 100 BNS; 17.5 ± 11.9 cm). Median follow-up was 1 year. Overall stent thrombosis rate was 6.1% (17/277) after a median of 43 days (range 2–192 days) and affected almost exclusively the femoropopliteal segment (12/60 in the CNS cohort vs. 4/100 in the BNS; p = 0.001). Annualized stent thrombosis rates (per 100 person-years) were 12.5% in case of CNS and 1.4% in case of BNS (HR 6.3, 95% CI 2.4–17.9; p = 0.0002). Corresponding major amputations rates were 8.7 and 2.5%, respectively (HR 4.5, 95% CI 2.7–27.9; p = 0.0006). On multivariable analysis, critical leg ischemia and CNS placement were the only predictors of stent thrombosis. Diabetes, critical leg ischemia, femoropopliteal anatomy, long stents and CNS were independent predictors of major amputations.ConclusionsPlacement of long femoropopliteal covered nitinol stents is associated with an increased incidence of acute stent thrombosis and ensuing major amputation. Risks are significantly lower in the aortoiliac vessels and with use of bare nitinol stents.

Incidence, Implications, and Predictors of Stent Thrombosis in Acute Myocardial Infarction

Stent thrombosis (ST) remains a catastrophic problem in patients undergoing percutaneous coronary intervention (PCI). However, a paucity of data exist regarding the incidence, implications, and predictors of ST in patients with acute myocardial infarction (AMI). We consecutively enrolled patients with AMI in the CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI registry who underwent PCI from January 2004 to December 2009 and analyzed definite or probable ST according to Academic Research Consortium definitions. The median follow-up duration was 41.9months. Definite or probable ST occurred in 136 patients (3.7%), including 44 with early ST (1.0%), 38 with late ST (0.9%), and 54 with very late ST (2.0%). The annual incidence of very late ST ranged from 0.5% to 0.6%. The all-cause mortality rate after ST was 29%, which was higher than that for patients without ST (17%; p <0.001). The independent predictors of ST were no-reflow phenomenon (hazard ratio [HR] 1.96, 95% confidence interval [CI] 1.28 to 3.03), decreased left ventricular ejection fraction (HR 1.70, 95% CI 1.21 to 2.40), anemia (HR 1.54, 95% CI 1.09 to 2.18), and a mean stent diameter <3.0mm (HR 1.53, 95% CI 1.04 to 2.27). ST is not uncommon in patients with AMI and continues to occur beyond 1year after PCI, irrespective of the stent type or clinical presentation. Patients with ST are associated with higher mortality than patients without ST. No reflow, decreased left ventricular ejection fraction, anemia, and a mean stent diameter <3.0mm are independent predictors of ST.

Prior chronic clopidogrel therapy is associated with increased adverse events and early stent thrombosis.

Despite the growing use of clopidogrel, limited data exist regarding the prognostic significance of chronic clopidogrel therapy in patients sustaining acute coronary syndrome (ACS). Our aim was to determine whether patients sustaining ACS while on chronic clopidogrel therapy have a worse prognosis than clopidogrel-naïve patients. A total of 5,386 consecutive ACS patients were prospectively characterised and followed-up for 30 days. Of them, 680 (13%) were treated with clopidogrel prior to the index ACS. Major adverse cardiovascular events (MACE) were defined as death, recurrent ACS, stroke and/or stent thrombosis. Compared with clopidogrel-naïve, chronic clopidogrel-treated patients were older (66 ± 12 vs 63 ± 13, respectively; p<0.01), suffered more from diabetes mellitus, hypertension, dyslipidaemia, prior cardiovascular history, including prior myocardial infarction, revascularisation, coronary artery bypass graft and stroke (p<0.01 for all), and were less likely to present with ST-elevation myocardial infarction (21% vs 45%; respectively; p < 0.001). Prior clopidogrel therapy was associated with a two-fold increase in in-hospital (1.6% vs 0.6%, respectively; p =0.006) as well as 30-day stent thrombosis (2.2% vs 1.0%, respectively; p=0.007). MACE at 30 days was also higher among chronic clopidogrel-treated compared with clopidogrel-naïve patients [12.3% vs 9.4%, respectively; p<0.01]. In multivariate log regression analysis chronic clopidogrel treatment was an independent predictor of stent thrombosis [OR=2.6 (95%CI 1.2-5.6), p=0.001]. Patients sustaining ACS while on chronic clopidogrel treatment are at higher risk for in-hospital and 30-day adverse outcomes, including stent thrombosis.

Impact of ultra‐long second‐generation drug‐eluting stent implantation

This study investigated the safety and prognosis of ultra-long second DES (UL-2nd DES) implantation in real-world practice. Long stenting is a widely known predictor of stent thrombosis (ST) or target lesion revascularization (TLR) in first-generation drug-eluting stents (DES). Participants were 1,669 patients (2,763 lesions) who had undergone successful second DES implantation; they were assigned to one of three groups: ultra-long 2nd DES (UL-DES; >50 mm, 166 patients, 259 lesions), long second DES (L-DES; 20-50 mm, 758 patients, 1,212 lesions), or short second DES (S-DES; <20 mm, 745 patients, 1,292 lesions). The primary endpoint was TLR, and secondary endpoints were ST, cardiac death, and major adverse cardiac events (MACE; composite of TLR, ST and cardiac death). A Cox proportional hazards model was used to identify independent predictors of TLR. Patient characteristics including dual antiplatelet therapy duration were similar across groups. Follow-up data were obtained from hospital charts, by contacting patients. Target lesion characteristics in the UL-DES group showed higher right coronary artery and chronic total occlusion lesion rates. TLR rates (23.1 ± 13.2 months) were significantly higher in the UL-DES group relative to other groups during follow up (P < 0.001). TLR rate was similar between S-DES and L-DES (P = 0.30). The incidence of ST was similar across groups (P = 0.40). MACE was significantly higher in the UL-DES group relative to other groups due to higher TLR rates (P = 0.01). In a Cox proportional hazard model, hemodialysis (RR: 2.53, 95% CI: 1.69-3.67, P < 0.001) and total stent length of >50 mm (RR: 1.67, 95% CI: 1.07-2.55, P = 0.02) were independent predictors of TLR. Ultra-long DES implantation was associated with higher TLR rates but did not increase ST, while long DES implantation up to 50 mm was safe and acceptable.

TCTAP A-148 Comparison of Predictors of Stent Thrombosis Between 1st Generation and 2nd Generation Drug-Eluting Stents Deployment in Patients with Acute Myocardial Infarction

TCTAP A-148 Comparison of Predictors of Stent Thrombosis Between 1st Generation and 2nd Generation Drug-Eluting Stents Deployment in Patients with Acute Myocardial Infarction

0109: Is there a differential expression of selected microRNAs depending on stent’s type and length one month after coronary angioplasty?

Stent thrombosis is a serious, although rare, complication of percutaneous coronary intervention (PCI). Some data from randomized trials indicate a higher risk for drug- eluting stents (DES) thrombosis. Furthermore, it has been shown that the most powerful histological predictor of stent thrombosis was endothelial coverage and that reendothelialization was delayed after implantation of first-generation DES compared with baremetal stents (BMS) as from the first month after PCI. We do not have yet simple blood test biomarkers that could reflect the ongoing process of stent reendothelialization. MicroRNAs are small, endogenous, noncoding RNAs, easily detectable in plasma, involved in a variety of cellular processes via suppression of specific target mRNAs and could be such biomarkers. Some of them have been linked to endothelial function and reendothelialization in animal or in vitro studies. We hypothesized that the expression of certain microRNAs was informative of stent endothelialization. We therefore sought beforehand to determine wether stent type and stent length could influence the expression of candidate microRNAs in human peripheral blood. Between July 2008 and December 2013, all patients who underwent coronary angioplasty in our centre were asked to attend a systematic consultation one month after revascularization for blood sampling. Sixty patients with a single-vessel disease meeting over twenty clinical, biological, echocardiographic and angiographic criteria were selected: 30 with a BMS and 30 with a DES, with a balanced ratio of short (≤15mm) and long (>15mm) stents in each group. Twenty eight microRNAs were chosen based on a review of literature. Their expression was measured using qRT-PCR in plasma samples collected at one month. Levels were normalized to cel-miR-39 and compared between the two groups of patients. The results are currently under analysis (table next page).

TCT-468 Predictors Of Stent Thrombosis After Primary Percutaneous Coronary Intervention And Risk for 30-Day Mortality: Analysis from the HORIZONS-AMI and EUROMAX trials

TCT-468 Predictors Of Stent Thrombosis After Primary Percutaneous Coronary Intervention And Risk for 30-Day Mortality: Analysis from the HORIZONS-AMI and EUROMAX trials

TCT-647 Predictors of Stent Thrombosis up to 12 Years Follow-up After Drug-Eluting Stent Implantation in Daily Clinical Practice

TCT-647 Predictors of Stent Thrombosis up to 12 Years Follow-up After Drug-Eluting Stent Implantation in Daily Clinical Practice

Abstract 165: Premature Clopidogrel Discontinuation after Drug-Eluting Stent Placement

Background: Clopidogrel non-adherence is a strong predictor of stent thrombosis, myocardial infarction, and death after drug-eluting stent (DES) placement. Previous studies on the prevalence of premature clopidogrel discontinuation are based on self-report and have short follow-up. Methods: All patients who underwent DES placement between January 2007 and December 2011 at Parkland Memorial Hospital were considered for inclusion; those with &lt; 1 year follow-up were excluded. We retrospectively collected one-year refill data from a large, closed (county hospital subsidized care) pharmacy system. Our primary outcome was time to failure to obtain a clopidogrel refill, allowing a 5-day grace period. Results: Of 452 patients (61% male, 38% Hispanic, 29% White, 24% African American) meeting entry criteria English was preferred by 71% of study patients, while 27% preferred Spanish. Median time to failure to obtain a clopidogrel refill was 91 days (Figure). By 6 months 58% of patients and by 12 months 85% of patients had failed to obtain a refill allowing a 5-day grace period. At follow-up 26% of patients had failed to obtain their first refill within 5-days after first prescription ending. By one year follow-up, 21% of patients had 100% proportion of days covered (PDC), 60% had PDC ≥ 80%, and 40% had PDC &lt; 80%. Conclusions: We identified a high prevalence of clopidogrel non-adherence in a multi-ethnic urban poor patient population, despite the facts that clopidogrel was provided on discharge and at nominal cost ($5 per month) thereafter, that patients were identified by treating physicians as likely to adhere to treatment, and that intensive patient education on the importance of clopidogrel adherence post-DES was routinely provided. These data call into question the implicit assumptions made about clopidogrel adherence in routine clinical practice.