Rate Of Early Stent Thrombosis Research Articles

Validity of the Stent Thrombosis Risk Score in Predicting Early Stent Thrombosis after Primary Percutaneous Coronary Intervention.

BackgroundThe thrombosis of the stent is one of the most important complications of percutaneous interventions, resulting in complete occlusion of the stented vessel. Aim of this study was to determine the validity of Stent Thrombosis Risk Score (STRS) in predicting early stent thrombosis (ST) after primary Percutaneous Coronary Intervention (PCI).MethodsFor this study, 569 consecutive patients undergone primary PCI from July 2018 to December 2018 were recruited. Early ST was defined as ST occurred during or within 30 days after the procedure. The STRS was calculated as proposed, developed, and validated in a past study. The receiver operating characteristic curve analysis was performed to determine the optimal cut-off value and area under the curve (AUC).ResultsA total of 569 patients were included, the median age was 56 [61–50] years. Early ST was observed in 33 (5.8%) patients. The median STRS was 4 [5–3] vs. 3 [4–2]; p = 0.009 for patients with and without Early ST respectively. STRS was found to be an independent predictor of early ST with an adjusted odds ratio of 1.41 (1.02–1.95). AUC was 0.631 and the optimal cut-off value was ≥5. Early ST rate was 3.3% at STRS of 0–2, which raised to 5.0% at STR of 3–4, and 17.2% at STRS of ≥5.ConclusionsIn conclusion, STRS was found to be an independent predictor of early ST after primary PCI and has significant discriminating power. The rate of early stent thrombosis after primary PCI exponentially increased at STRS cut-off value of ≥5.

100.61 Comparison of Thromboresistance and Albumin Retention Between the Resolute Onyx Drug-Eluting Stent and Onyx Bare Metal Stent Platforms

Recent clinical studies demonstrated lower rates of early stent thrombosis with a durable-polymer drug eluting stents (DES) relative to bare metal stents (BMS), supporting the idea that polymers/drug carrier on stents may contribute to the superior clinical outcomes with regard to stent thrombosis

Early and Late Stent Thrombosis in Patients with Versus Without Diabetes Mellitus Following Percutaneous Coronary Intervention with Drug-Eluting Stents: A Systematic Review and Meta-Analysis.

Nowadays, drug-eluting stents (DES) are most commonly used compared with bare metal stents (BMS) since the former are associated with significantly lower rates of revascularization following percutaneous coronary intervention (PCI). However, unpredictable in-stent thrombosis is a major concern with DES, especially in patients with diabetes mellitus. In this analysis, we aimed to systematically compare early and late stent thrombosis in patients with versus without diabetes mellitus following PCI with DES. Studies were included if they were randomized controlled trials or observational studies comparing patients with diabetes mellitus versus those without it following PCI with DES and they reported acute and sub-acute/early and late stent thrombosis among their clinical outcomes. Early stent thrombosis was defined as stent thrombosis that occurred before 30days and late stent thrombosis was defined as stent thrombosis that occurred after 30days following PCI. The statistical analysis was carried out by the new version of the RevMan software (version 5.3), and odds ratios (ORs) and 95% confidence intervals (CIs) were considered as the statistical parameters. A total number of 18,910 patients were included in this analysis comparing early and late stent thrombosis in patients with diabetes mellitus (5123 patients) and in patients without diabetes mellitus (13,787 patients). Both groups of patients had similar rates of early stent thrombosis, with an OR of 1.30 (95% CI 0.89-1.91; P = 0.18, I2 = 9%) (4962 patients with diabetes mellitus were compared with 13,392 patients without diabetes mellitus). However, late stent thrombosis was significantly higher in patients with diabetes mellitus, with an OR of 1.95 (95% CI 1.35- 2.81; P = 0.0004, I2 = 0%) (5113 patients with diabetes mellitus and 13,775 patients without diabetes mellitus were compared). Both patients with and without diabetes mellitus had a similar rate of early stent thrombosis following PCI with DES. However, diabetes mellitus was associated with a significantly higher rate of late stent thrombosis.

Incidence and Clinical Features of Early Stent Thrombosis in the Era of New P2y12 Inhibitors (PLATIS-2).

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.

BIVALIRUDIN WITH PROVISIONAL GLYCOPROTEIN IIB/IIIA INHIBITORS COMPARED TO HEPARIN WITH PLANNED OR PROVISIONAL GLYCOPROTEIN IIB/IIIA INHIBITORS IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: NETWORK META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

In some randomized clinical trials (RCT), bivalirudin(Biv) -based anticoagulation led to reduced mortality compared with heparin(Hep) -based regimens during PCI. The mortality benefit may be related to lower rates of major bleeding (MB), at the expense of higher rates of early stent thrombosis (ST

Stent thrombosis in patients with coronary artery disease treated with biodegradable polymer drug-eluting stents: an update meta-analysis.

Delayed re-endothelialization may be the pathophysiological cause of stent thrombosis (ST). Biodegradable polymer drug-eluting stents (BP-DES) may reduce the risk of ST. The aim of this study was to evaluate the risk of ST in patients treated with BP-DES. Studies were retrieved from the PubMed, Cochrane Library, and EMBASE online databases. Twelve studies (15,155 patients) with long-term follow-up (≥ 12 months) were included. Compared with durable polymer drug-eluting stents (DP-DES), BP-DES did not significantly decrease the risk of definite and probable ST (RR, 0.89; 95% CI, 0.68 to 1.18; P = 0.425) and definite ST (RR, 0.92; 95% CI, 0.66 to 1.30; P = 0.648). Furthermore, there was no difference in the risk of late ST (RR, 1.17; 95% CI, 0.39 to 3.53; P = 0.780). However, the rate of early ST was slightly higher in the BP-DES group (RR, 1.60; 95% CI, 0.94 to 2.73; P = 0.084) than in the DP-DES group. A significant reduction in very late ST (> 12 months) was evident with the BP-DES group (RR, 0.27; 95% CI, 0.10 to 0.68; P = 0.006). Subgroup analysis showed that there was no difference in the rate of definite and probable ST between the BP-DES and first- or second-generation DES groups.Biodegradable polymer stents were associated with a significantly lower risk of very late ST. However, there was no difference in the risk of definite and probable ST between the two groups.

Usefulness of the RISK-PCI score to predict stent thrombosis in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a substudy of the RISK-PCI trial

Stent thrombosis (ST) is an important cause of death after primary percutaneous coronary intervention (pPCI). This substudy aimed at evaluating the usefulness of the RISK-PCI score, originally developed for the prediction of 30-day major adverse cardiovascular events, to predict the occurrence of ST after pPCI. We analyzed 1972 consecutive patients who underwent pPCI with stent implantation between February 2007 and December 2009. Early ST (EST), late ST (LST), and cumulative 1-year ST (CST) were the predefined end points. Definite, probable, and possible ST were included. Models discrimination and calibration to predict ST was tested using receiver-operating characteristics curves and the goodness-of-fit (GoF) test. Sensitivity analyses and 1000-resample bootstrapping were used to evaluate the model's performance. The rates of EST, LST, and CST were 4.6, 1.4, and 6.0 %, respectively. Compared with controls, the cumulative ST group was associated with much higher rates of adverse clinical outcomes at 30-day follow-up (adjusted odds ratio (OR) for death 6.45, adjusted OR for major bleeding 4.41) and at 12-month follow-up (adjusted OR for death 7.35, adjusted OR for major bleeding 4.56). Internal validation confirmed a reasonably good discrimination and calibration of the RISK-PCI score for the prediction of EST (area under the curve (AUC) 0.71, GoF 0.42), LST (AUC 0.69, GoF 0.36), and CST (AUC 0.70, GoF 0.22) after pPCI. ST after pPCI is associated with adverse 30-day and 1-year clinical outcomes. We conclude that the risk of ST could be accurately assessed using the RISK-PCI score, which might help in deciding upon measures aimed at preventing adverse prognosis.

Personalized Antiplatelet Therapy: Review of the Latest Clinical Evidence

P2Y12-ADP receptor antagonist use has been critical in the development of percutaneous coronary intervention, dramatically reducing the rate of early stent thrombosis. However, it recently was observed that a significant proportion of patients do not achieve optimal platelet reactivity inhibition after clopidogrel loading dose. The large interindividual variability in clopidogrel responsiveness is related to several factors, including the genetic polymorphism of hepatic cytochrome P450 2C19 (CYP2C19*2), which recently has been highlighted by a warning from the U.S. Food and Drug Administration. Of importance, patients exhibiting reduced clopidogrel metabolism and/or low clopidogrel responsiveness (ie, high on-treatment platelet reactivity) have an increased rate of thrombotic events after percutaneous coronary intervention. This review summarizes the current knowledge on this important clinical issue. While the future of genetic testing remains undetermined, several trials are underway to demonstrate the potential utility of platelet reactivity testing with P2Y12-ADP receptor antagonists.

Prediction and prevention by progenitors? Stent thrombosis and EPCs

This editorial refers to ‘Circulating endothelial progenitor cell levels and function in patients who experienced late coronary stent thrombosis’[†][1], by E.I. Lev et al. , on page 2625 During the late 1980s balloon-expandable vascular stents were developed to prevent abrupt closure and restenosis after angioplasty.1 Their initial success was hampered by an overwhelming rate of early stent thrombosis. Introduction of P2Y-receptor antagonists (i.e. ticlopidine and clopidogrel) for platelet inhibition in combination with acetylsalicylic acid greatly reduced this often fatal complication. Large long-term clinical studies, however, identified in-stent restenosis as an additional hindrance of sustained success. New drug-eluting stents (DES) promised to inhibit the pathological vascular smooth muscle cell migration and proliferation and proteoglycan deposition responsible for restenosis. To the dismay of all of us, the reduced risk of restenosis with DES was accompanied by an increased stent thrombosis rate. Unlike stent thrombosis after implantation of a bare metal stent, which generally occurs within the first 2 weeks, late (>30 days) and very late (>1 months) stent thrombosis is not infrequent after implantation of a DES.2 The main contributors leading to stent thrombosis include procedure-related factors such as stent diameter and length, apposition or expansion, patient-related factors including reduced ejection fraction, diabetes mellitus, or advanced age, antiplatelet-related factors comprising different drugs and individual responsiveness, stent thrombogenicity-related factors incorporating strut thickness, polymer type, and polymer thickness, and, most importantly, local and systemic factors influencing endothelial integrity, activation, and re-endothelialization.3 In in-stent thrombus formation, the initial tethering of platelets is activated by free stent struts and extracellular matrix proteins. It is mediated by the glycoprotein Ib/V/IX receptor complex and its major ligand von Willebrand factor.4 After the initial platelet adhesion, autocrine and paracrine mediators, including adenosine diphosphate (ADP), thrombin, epinephrine, and thromboxane A2, amplify and sustain the platelet response by … *Corresponding author. Tel: +49 228 2871 5217/5218, Fax: +49 228 2871 6423, Email: georg.nickenig{at}ukb.uni-bonn.de [1]: #fn-2

Antithrombotische Therapie bei Patienten mit Indikation zur oralen Antikoagulation und koronarer Stentimplantation

Patients with coronary stent implantation are treated with dual antiplatelet therapy with aspirin and a thienopyridine. This combination therapy reduced the rate of early stent thrombosis and allowed the widespread use of coronary stents, which are currently implanted in about 90% of patients with PCI. In patients with bare metal stents, the recommended duration of dual antiplatelet therapy is 4 weeks, while 6-12 months is recommended in patients with drug-eluting stents. However, problems arise in patients needing oral anticoagulation. Combination therapy with oral anticoagulation and antiplatelet therapy is associated with an increase in bleeding complications. So far no randomized studies have defined the optimal intensity and duration of antithrombotic therapy in these patients. Therefore the decision should be made based on an individual risk assessment for stent thrombosis and bleeding in each patient.

Tailored Clopidogrel Dosing Reduces Adverse Events in Patients with Clopidogrel Resistance Undergoing PCI

For patients who undergo nonemergent percutaneous coronary intervention (PCI), tailoring the loading dose of clopidogrel according to platelet reactivity reduced the rate of early stent thrombosis, according to findings from a new trial. Individualized dosing also reduced the incidence of major adverse cardiovascular events without increasing bleeding events.

Tailored Clopidogrel Loading Dose According to Platelet Reactivity Monitoring to Prevent Acute and Subacute Stent Thrombosis

Stent thrombosis remains a significant pitfall of percutaneous coronary intervention (PCI). A recent trial observed that an adjusted loading dose (LD) of clopidogrel according to platelet monitoring decreases the rate of major adverse cardiovascular events after PCI. We investigated if such a strategy of a tailored clopidogrel LD according to platelet reactivity monitoring could decrease the rate of stent thrombosis. This multicenter prospective randomized study included 429 patients with a low clopidogrel response after a 600-mg LD undergoing PCI. Patients were randomized to a control group (n = 214) and to a vasodilator-stimulated phosphoprotein (VASP)-guided group (n = 215). In the VASP-guided group, patients received up to 3 additional 600-mg LDs of clopidogrel to obtain a VASP index <50% before PCI. The primary end point was the rate of stent thrombosis at 1 month. Secondary end points were rates of major adverse cardiovascular events and bleeding. Patients in the 2 groups had a high body mass index and were often diabetic (control vs VASP-guided group 28 +/- 5.1 vs 27.9 +/- 4.7 kg/m(2), p = 0.8, and 39% vs 33%, p = 0.2, respectively). PCI was performed in most patients for acute coronary syndrome in the 2 groups (52.3% vs 50.7%, p = 0.8). Despite a 2,400-mg LD of clopidogrel, 8% of patients in the VASP-guided group remained low responders. The rate of stent thrombosis was significantly lower in the VASP-guided group (0.5% vs 4.2%, p <0.01). The rate of major adverse cardiovascular events was also higher in the control group (8.9% vs 0.5%, p <0.001). There was no difference in the rate of bleeding (2.8% vs 3.7%, p = 0.8). In conclusion, a tailored clopidogrel LD according to platelet reactivity monitoring decreases the rate of early stent thrombosis after PCI without increasing bleeding.

Four-Year Clinical Follow-Up of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital Registry

Although the safety of drug-eluting stents has been under considerable scrutiny, limited real-world follow-up data extending up to 4 years are available. The randomized clinical trials carefully selected patients and are not reflective of everyday practice. From April to October 2002, 508 consecutive patients treated with sirolimus-eluting stents (SES) were enrolled. The control group consisted of 450 patients treated with bare-metal stents during the preceding 6 months. After 4 years of follow-up, the incidence of composite major adverse clinical events (all-cause death, myocardial infarction, or target vessel revascularization) was found to be significantly lower in the SES group (23.0% vs 28.7%, adjusted hazard ratio 0.66, 95% confidence interval 0.51 to 0.86), as were rates of target vessel revascularization (12.2% vs 17.8%, adjusted hazard ratio 0.57, 95% confidence interval 0.39 to 0.83). There were no differences in all-cause mortality (10.5% for SES vs 10.6% for bare-metal stents, p = 0.9) or in the rates of cardiac death (4.5% vs 6.9%, p = 0.1). Although there was no difference in overall stent thrombosis (2.3% vs 2.2%, p = 1.0), SES had a higher rate of very late stent thrombosis (1.4% vs 0%, p = 0.02), balanced by a lower rate of early stent thrombosis (0.4% vs 1.8%, p = 0.05). In conclusion, after 4 years, SES were found to remain safe and effective compared with bare-metal stents. Nevertheless, the higher rate of very late stent thrombosis remains a concern. Longer term follow-up will be required to determine the extent of this problem.