Stent Thrombosis In Patients Research Articles

Clinical effectiveness of thrombus aspiration during percutaneous coronary intervention for stent thrombosis in a contemporary setting

ObjectiveThe impact of adjunctive manual thrombus aspiration (TA) in patients with stent thrombosis (ST) treated with percutaneous intervention has not been evaluated in the current era of potent P2Y12 agents and new-generation drug-eluting stents. We sought to assess the effect of TA using data from a large contemporary registry. MethodsThe study population was derived from the Essex ST Investigation Registry (ESTHIR), which contains all consecutive cases of angiographically determined definite ST undergoing interventional treatment in a tertiary cardiac centre between November 2015 and June 2018. Propensity score matching was performed to match patients who underwent TA (TA group) to those who did not (n-TA group). The study endpoints were final TIMI flow and survival free of cardiovascular death (CD) or target lesion revascularisation (TLR). ResultsA total of 128 ST patients were included in the present analysis. The mean age was 65 ± 11 years, and 84% were male. About 90% of the patients presented with STEMI, and 85% had very late ST. Seventy-two patients (56%) underwent TA. After propensity score matching, 30 patients were included in each study group. A higher rate of final TIMI III flow was observed in the TA group (TA vs n-TA group, 100% vs 83%), but this difference did not reach statistical significance (p = 0.052). At 1000 days of follow-up, survival free of CD or TLR was not different between the two groups (p = 0.8). ConclusionIn a propensity-matched population of ST patients undergoing PCI in a contemporary setting, TA was not associated with improved final TIMI flow or long-term cardiovascular outcomes.

Relationship between atherogenic index of plasma and stent thrombosis in patients with acute coronary syndrome.

Stent thrombosis (ST) is an uncommon but serious complication in patients undergoing percutaneous coronary intervention (PCI). This study aimed to investigate the effect of atherogenic index of plasma (AIP) on ST. Among the 10,258 patients who underwent coronary angiography between January 2018 and December 2020, 239 patients who underwent PCI with the diagnosis of acute coronary syndrome (ACS) due to ST were included as the study group (ST group) and 459 patients who underwent percutaneous intervention for ACS and did not have any in-stent lesion as the control group (non-ST group). ST classification was done according to the Academic Research Consortium definition. The mean age of the patients was 63.3±10.6 years (483 male, 69.2%). The groups were similar in terms of characteristic properties, comorbidities, and the drugs being used (p>0.05 for all). Drug eluting stents were used in 86.5% of the patients. In the ST group, the median time from stent implantation to thrombosis was 285 days. Mean AIP and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) were statistically significantly higher in the ST group than in the controls (p<0.001 and p=0.018, respectively), and a positive correlation was observed between time from stent implantation to thrombosis and AIP and TG/HDL-C (rS=0.229, p=0.010 and rS=0.222, p=0.010, respectively). Multivariate logistic regression analysis revealed that stent length, prior ST elevation myocardial infarction, TG/HDL-C, and AIP were independent predictors of ST. AIP is an easy calculable biomarker, and the performance of AIP to predict ST is better than TG/HDL-C.

600 Validation of the academic research consortium high bleeding risk criteria in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of 10 studies and 67 862 patients

Abstract Aims The Academic Research Consortium for High Bleeding Risk (ARC-HBR) has recently proposed, by consensus, 20 clinical criteria for the assessment of the bleeding risk after percutaneous coronary intervention (PCI). A major criterion was defined as any individual clinical condition conferring in isolation a risk for major bleeding ≥4% up to 1 year after PCI; instead, a minor criterion was considered to confer a bleeding risk of &amp;lt; 4%. The aim of this meta-analysis was to assess the performance of the ARC-HBR criteria in stratifying the risk of bleeding and ischaemic events after PCI. Methods and results MEDLINE, COCHRANE, Web of Sciences, and SCOPUS were searched for studies aimed at validating the ARC-HBR criteria in patients treated with PCI. The primary outcome measure of this meta-analysis was major bleeding. The analysis included 10 studies encompassing 67 862 patients undergoing PCI; the HBR definition was fulfilled in 44.7% of the cases. The risk of major bleeding was significantly higher in HBR vs. Non-HBR group (RR: 2.56, 95% CI: 2.28–2.89). The average C-statistic was 0.64 (95% CI: 0.60–0.68), indicating modest discrimination. The risk of intracranial haemorrhage, gastrointestinal bleeding, fatal bleeding, ischaemic stroke, cardiac death and all-cause death was higher in HBR vs. Non-HBR group. Despite a higher incidence of myocardial infarction and stent thrombosis in patients deemed at HBR, the rate of target lesion revascularization was comparable between groups (RR, 1.01, 95% CI: 0.88–1.16). When assessed in isolation, the mean cumulative incidence of major bleeding at 1 year exceeded the cut-off value of 4% for all the major criteria and for two out of six minor criteria, including age ≥75 years and moderate chronic kidney disease (CKD) (Figure). Conclusions The ARC-HBR definition identifies patients at higher risk of major bleeding and other adverse cardiovascular events after PCI. Almost all major criteria, but also two of the minor criteria, were individually associated with rates of major bleeding above 4% thus fulfilling the definition of major HBR criteria. These findings corroborate the ability of ARC-HBR major criteria in identifying PCI patients who are more likely to develop adverse events, but also suggest caution in the decision making of patients with isolated minor criteria, including age ≥ 75 years and moderate CKD.

Development of “STORE” (stent thrombosis risk evaluation) score to predict stent thrombosis in patients treated with percutaneous coronary intervention for ACS – A study from South India

Development of “STORE” (stent thrombosis risk evaluation) score to predict stent thrombosis in patients treated with percutaneous coronary intervention for ACS – A study from South India

Validation of the academic research consortium high bleeding risk criteria in patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis of 10 studies and 67,862 patients

BackgroundTo assess the performance of the Academic Research Consortium High Bleeding Risk (ARC-HBR) criteria in stratifying the risk of bleeding and ischaemic events after percutaneous coronary intervention (PCI). MethodsMEDLINE, COCHRANE, Web of Sciences, and SCOPUS were searched for studies aimed at validating the ARC-HBR criteria in patients treated with PCI. The primary outcome measure of this meta-analysis was major bleeding. ResultsThe analysis included 10 studies encompassing 67,862 patients undergoing PCI; the HBR definition was fulfilled in 44.7% of the cases. The risk of major bleeding was significantly higher in HBR vs. Non-HBR group (RR, 2.56, 95% CI 2.28–2.89). The average C-statistic was 0.64 (95% CI 0.60–0.68), indicating modest discrimination.The risk of intracranial hemorrhage, gastrointestinal bleeding, fatal bleeding, ischaemic stroke, cardiac death and all-cause death was higher in HBR vs. Non-HBR group. Despite a higher incidence of myocardial infarction and stent thrombosis in patients deemed at HBR, the rate of target lesion revascularization was comparable between groups (RR, 1.01, 95% CI 0.88–1.16).The mean effect size for the cumulative incidence of major bleeding exceeded the HBR cut-off value of 4% for all major criteria except one, and for two out of six minor criteria, namely age ≥ 75 years and moderate CKD. ConclusionThe ARC-HBR definition identifies patients at higher risk of major bleeding and other adverse cardiovascular events after PCI. Almost all major criteria, but also two of the minor criteria, were individually associated with rates of major bleeding above 4% thus fulfilling the definition of major HBR criteria.

Immediate postprocedure anticoagulation with factor Xa inhibitors of venous stents for nonthrombotic venous lesions does not increase stent patency

BackgroundMany clinicians will prescribe anticoagulation therapy for patients after iliac vein stenting to prevent early or late stent thrombosis. At present, it is unknown whether therapeutic anticoagulation has any effect on stent patency. Thus, we assessed the role of short-term anticoagulation on iliac vein stent patency in patients with nonthrombotic iliac vein lesions (NIVLs). MethodsWe performed a retrospective medical record review of all iliac vein stents placed for NIVLs at the Center for Vascular Medicine from January 2018 to December 2019. We compared the stent patency in the two groups. The anticoagulation (AC) group had received rivaroxaban or apixaban postoperatively for a minimum of 90 days and were compared with a group that had received no postoperative anticoagulation (NAC). Stent patency was assessed using transabdominal ultrasound at 3, 6, 12, 18, 24, and 30 months. At the discretion of the treating physician, the patients who demonstrated thrombus layering on surveillance ultrasound scanning continued rivaroxaban or apixaban until thrombus resolution was observed. The demographics and stent location, diameter, and length were assessed. Stent patency was analyzed using life table analyses. Differences in stent patency were analyzed using GraphPad Prism, version 8, statistical software (GraphPad Software Inc, La Jolla, Calif) and the log-rank (Mantel-Cox) test. ResultsThe number of patients and stents in each group were as follows: AC group, 299 patients and 308 stents; and NAC group, 77 patients and 90 stents. The average age was 52.24 ± 13.44 years and 55.63 ± 14.49 years in the AC and NAC groups, respectively (P ≤ .065). Women constituted 76% of the patients in the AC group and 72% in the NAC group. The average stent diameter and length for the AC group was 20 ± 2 mm and 77 ± 13 mm and for the NAC group was 19 ± 2 mm and 82 ± 9 mm, respectively. The stents had been placed in the right common iliac vein, bilaterally, or left common iliac vein territory in 15%, 3%, and 82% in the AC group and 18%, 2%, and 80% in the NAC group, respectively. The cumulative stent patency at 30 months was 98.7% and 94.6% for the NAC and AC groups, respectively (P ≤ .83). All the stents placed were Wallstents (Boston Scientific, Marlborough, Mass). A total of eight insertion site thromboses occurred that did not affect stent patency: five in the AC group (1.6%) and three in the NAC group (4.5%; P = .15). In addition, 19 patients demonstrated evidence of thrombus layering, with 6 receiving extended anticoagulation. ConclusionsOur data indicate that perioperative stent thrombosis in patients with NIVLs is uncommon. Thus, anticoagulation for perioperative stent thrombosis prophylaxis is not necessary. Anticoagulation should only be used for patients with insertion site thromboses and should be considered if thrombus layering is observed on surveillance scanning.

D-dimer as a potential novel thrombus biomarker for predict stent thrombosis in patients on dual antiplatelet therapy after percutaneous coronary intervention

Abstract Background At present, it is worth noting that there is a lack of biomarker for the residual risk of thrombosis in patients underwent percutaneous coronary intervention (PCI). D-dimer is an important thrombus marker and widely used in clinical practice. Purpose We aim to investigate the correlation between D-dimer and the risk of stent thrombosis (ST) after PCI. Method This is a prospective, observational study of 10,724 patients who underwent PCI. The primary endpoint was ST, which was defined according to the Academic Research Consortium including definite, probable, and possible. Results Finally, 8565 patients were included in this study after excluding 2159 people with missing D-dimer data or lost to follow-up. After 2-year follow-up, there were 77 ST occurred. D-dimer levels were significantly higher in the ST group (0.33 [0.28, 0.56] μg/ml) than in the non-ST group (0.28 [0.20, 0.41] μg/ml) (P=0.001). Kaplan–Meier survival curve analysis showed that patients with high D-dimer levels had higher cumulative ST according to the median D-dimer level (0.28 μg/ml) in the total population, acute coronary syndrome (ACS) subgroup, and stable coronary artery disease (SCAD) subgroup, respectively. (log-rank test, all P&amp;lt;0.001) (Figure 1). After multivariate-adjusted cox hazard analysis, high D-dimer levels (≥0.28 μg/ml) were significantly associated with ST in the total population (hazard ratio [HR]: 2.25, 95% confidence interval [CI]: 1.29–3.95, P=0.005) and ACS subgroup (HR: 2.13, 95% CI: 1.09–4.16, P=0.027); however, we did not find a statistically significant in the SCAD subgroup (HR: 2.56, 95% CI: 0.92–7.1, P=0.072). Conclusion In this real world and large sample data study, we reported for the first time that D-dimer was strong independent thrombosis biomarker in patient who underwent PCI. In the future, we may use D-dimer to guide individualized antithrombotic therapy after PCI. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): CAMS Innovation Fund for Medical Sciences; Young and middle-aged talents in the XPCC Science and Technology Project

Гострий тромбоз стента при інфаркті міокарда, ускладненому кардіогенним шоком, за наявності цукрового діабету 2-го типу

Актуальність. Гострий тромбоз стента (ТС) є нечастим, але грізним ускладненням при стентуванні вінцевих артерій. Він виникає під час черезшкірних коронарних втручань або впродовж 24 годин після цієї процедури. Мета дослідження: з’ясувати причини та проаналізувати фактори, що призвели до гострого ТС при гострому коронарному синдромі і цукровому діабеті (ЦД) 2-го типу, для уникнення подібних ускладнень. Матеріали та методи. Обстежено 119 пацієнтів із гострим інфарктом міокарда з елевацією сегмента ST, які лікувалися в інфарктному відділенні комунального некомерційного підприємства «Клінічна лікарня швидкої медичної допомоги м. Львова». Усім пацієнтам проводили коронарографію та стентування вінцевих артерій, ультраструктурні дослідження тромбоцитів венозної крові за допомогою електронної мікроскопії. Результати. Пацієнти із ЦД 2-го типу мають вищий кардіоваскулярний ризик розвитку серцево-судинних ускладнень, що пов’язано з ендотеліальною дисфункцією, схильністю до гіперкоагуляції і, як наслідок, тенденцією до вазоконстрикції, запальних реакцій та порушень гемостазу. У цієї категорії пацієнтів спостерігається підвищена адгезивність тромбоцитів і збільшена концентрація тканинного активатора плазміногену. В експрес-некроптатах і періопераційних біоптатах міокарда пацієнтів із ЦД нами виявлено домінування процесів гіперкоагуляції в мікросудинах міокарда в результаті активності системи згортання крові за відсутності безпосередньої участі тромбоцитів, оскільки частина з них була кальцифікована (осміофільні) і мала знижену функціональну здатність, в результаті чого відмічається резистентність до аспірину. В осіб із ЦД 2-го типу виникає зазвичай тяжкий і більш генералізований коронаросклероз, що призводить до погіршення перебігу гострого коронарного синдрому і частішого виникнення ТС, що робить доцільним додаткове призначення ривароксабану цій категорії пацієнтів. Висновки. Враховуючи виявлені нами ознаки зниженої реактивності тромбоцитів і домінування активації системи згортання крові у хворих на ЦД і з підвищеним ризиком коронаротромбозу, вважаємо, що застосування нових пероральних антикоагулянтів є актуальним і заслуговує подальших досліджень.

Comparison between R2CHA2DS2-VASc Score and CHA2DS2-VASc Score to Predict Acute Stent Thrombosis in Patients with After Primary Percutaneous Coronary Intervention

Aim: Acute stent thrombosis (AST) is an important complication resulting from sudden vascular occlusion after stent implantation, especially in patients with ST-segment elevation myocardial infarction (STEMI). It occurs in about 1% of the patients after primary percutaneous coronary intervention. The CHA2DS2-VASc score is easily applied in daily practice and the components of this score are similar to common risk factors of the AST. Chronic renal disease has a hypercoagulable state and this condition is associated with an increased risk of AST in STEMI. Since the CHA2DS2-VASc score is insufficient to assess the risk of AST in patients with renal dysfunction, we aimed to investigate the prognostic significance of the modified score, R2CHA2DS2-VASc score in patients with AST.Methods:This cross-sectional study retrospectively included 56 patients withAST and 1493 patients without AST after STEMI. The CHA2DS2-VASc and R2CHA2DS2-VASc scores were compared between the two groups.Results:The median CHA2DS2-VASc and R2CHA2DS2-VASc scores were significantly higher in the AST group (P &amp;lt;0.001, P &amp;lt;0.001, respectively). The R2CHA2DS2-VASc score ≥2 was used as a predictor of the AST with a sensitivity of 65% and specificity of 89%.Conclusions: The R2CHA2DS2-VASc score is a simple, cheap, and easily accessible score that can predict AST.

Diabetes mellitus is independently associated with early stent thrombosis in patients undergoing drug eluting stent implantation: Analysis from the Victorian cardiac outcomes registry.

Diabetes mellitus (DM) is a predictor of restenosis and late stent thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting-stents (DES). Real-world data on rates of early ST is lacking. We compared clinical outcomes of patients with and without DM from the Victorian cardiac outcomes registry. Consecutive patients undergoing PCI with DES were analyzed with primary outcome being ST at 30-days. Secondary outcomes including major adverse cardiovascular events (MACE) and all-cause mortality. Of 43,209 patients included, 9730 (22.5%) had DM. At 30 days, DM was independently associated with higher rates of early ST (0.7% vs. 0.5%) OR 1.41 (95% confidence interval; 1.05-1.87, p=0.02), MACE (4.1% vs. 3.5%, p=0.004) and mortality (1.9% vs. 1.5%, p=0.01). Increased risk was not simply due to treatment. Patients with DM requiring insulin were equally affected in regard to MACE (4.7% vs. 3.9%, p=0.069) and mortality (1.9%, vs. 1.8%, p=0.746). On National Death Index linkage, patients with DM had increased all-cause mortality over five-year follow-up (OR 1.69 CI 1.55-1.83, p=< 0.001). In this large real-world-registry, DM was an independent predictor of early ST, MACE and mortality at 30 days. These data suggest additional therapeutic strategies are required to reduce the risk of early complications in patients with DM undergoing PCI with DES.

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.

Effect and significance of hyperlipoproteinemia on stent thrombosis in patients with implanted drug-eluting stents: The 5-year follow up study

Elevated blood lipid level, also known as hyperlipoproteinemia (HLP), is the most common metabolic disorder in the general population. According to US National Heart Institute data, about 36% of adults and 10% of children aged 9 to 12 have elevated cholesterol levels. The risk of ischemic heart disease increases by 2-3% with every 1% increase in total cholesterol levels. Therefore, men aged 55-65 with a 10% increase in total cholesterol have about 38% increased ischemic heart disease mortality. The study's main objective is to determine the occurrence of thrombotic complications in patients in whom first-generation drug-eluting stents are implanted and how these events are influenced by the presence of HLP. The study is retrospective, clinical, and non-interventional with a five-year follow-up period for each patient. Initially, 800 patients undergoing index percutaneous coronary angioplasty with sirolimus-eluting and paclitaxel-eluting stent implantation were enrolled. Clinical data collected included cardiac disorders, the presence of diabetes mellitus, hyperlipoproteinemia, and smoking as a risk factor. In the examined group of patients, stent thrombosis was monitored according to Academic Research Consortium (ARC) criteria. The study included 800 patients who underwent percutaneous coronary angioplasty index. At the end of the follow-up period, 701 patients (87.6%) completed the clinical trial and were included in the statistical analysis. Stent thrombosis, determined according to ARC criteria, was reported as 'definitive stent thrombosis' in 22 patients (3.06%), 'probable stent thrombosis' in 1 patient (0.14%), and 'possible stent thrombosis' in 1 patient (0.14%). Of the 404 patients with HLP, 120 patients had a total cholesterol value >300 mg/dL. Twenty patients with definitive stent thrombosis had cholesterol >300 mg/dL. Patients with probable and possible stent thrombosis did not have HLP. A comparison of patients with stent thrombosis, with HLP and without HLP, revealed a statistically significant difference (16.67% vs. 1.35%, p <0.001). Comparing patients with unstable angina pectoris, with cholesterol value >300 mg/dL and without HLP, a statistically significant difference was observed (71.7% vs. 17.2%, p <0.001). We report on the long-term follow up of patients with stent thrombosis after drug-eluting stent insertion with and without HLP. The results suggest that HLP influences the development of coronary disease, with a significant influence on complications following percutaneous coronary intervention.

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.

Effects of Simulated COVID-19 Cytokine Storm on Stent Thrombogenicity

BackgroundCytokine storm-related hypercoagulation may be important in the pathogenesis of stent thrombosis in patients with SARS-CoV-2. Whether stent polymers behave differently under such conditions has never been explored. MethodsFluorinated polymer-nanocoated and uncoated COBRA stents (CeloNova), BioLinx-polymer-coated Resolute Onyx stents (Medtronic), and Synergy stents (Boston Scientific), which are abluminally coated with a bioabsorbable polymer, were exposed to human blood from healthy donors which was supplemented with 400 pg/mL IL-6 and 100 pg/mL TNF-α, similar to what is seen in cytokine storm caused by SARS-CoV-2. Platelet adhesion and neutrophil activation, assessed by immunofluorescence, were compared under cytokine storm and control conditions (untreated blood) (n = 4 experimental runs). ResultsPlatelet adhesion values, defined as %platelet-covered area x staining intensity, were significantly lower in coated and uncoated COBRA and in Resolute Onyx than in Synergy under control conditions (1.28 × 107 ± 0.43 × 107 vs. 2.92 × 107 ± 0.49 × 107 vs. 3.57 × 107 ± 0.73 × 107 vs. 9.94 × 107 ± 0.99 × 107; p ≤0.0001). In cytokine storm, platelet adhesion values remained low in coated COBRA-PzF (1.78 × 107 ± 0.38 × 107) compared to all other devices (uncoated COBRA: 5.92 × 107 ± 0.96 × 107; Resolute Onyx: 7.27 × 107 ± 1.82 × 107; Synergy: 11.28 × 107 ± 1.08 × 107; p ≤ 0.0001). Although cytokine storm conditions significantly increased neutrophil activation in all stents, it was significantly less in coated and uncoated COBRA, and in Resolute Onyx than in Synergy. ConclusionsBlood-biomaterials interactions may determine the thrombogenic potential of stents. Under simulated cytokine storm conditions, fluoropolymer-coated stents showed the most favorable anti-thrombogenic and anti-inflammatory properties.

Effects of clopidogrel, prasugrel and ticagrelor on prevention of stent thrombosis in patients underwent percutaneous coronary intervention: A network meta-analysis.

BackgroundClopidogrel, prasugrel and ticagrelor, acting on platelet P2Y12 receptor, are commonly used for prevention of stent thrombosis (ST) among patients who underwent percutaneous coronary intervention (PCI). This study aimed to compare the effects of these drugs by a systematic review and network meta‐analysis.HypothesisEfficacies of clopidogrel, prasugrel and ticagrelor on preventing ST are not the same.MethodsPubMed, Embase and Cochrane Library were searched for randomized controlled trials (RCTs) that investigated the effect of clopidogrel, prasugrel, or ticagrelor on prevention of ST in patients who underwent PCI. The efficacies between groups were compared by a Bayesian network meta‐analysis, by which the pooled odds ratios (ORs) and 95% confidence intervals (CIs) was calculated.ResultsFourteen studies and 46 983 participants were included in this study. The pooled results illustrated that clopidogrel, prasugrel and ticagrelor were effective on prevention of ST. Patients treated with prasugrel (OR = 0.30, 95% CI = 0.052 ~ 0.73, P < 0.05) and ticagrelor (OR = 0.25, 95% CI = 0.035 ~ 0.65, P < 0.05) had lower incidence of ST compared to those treated with clopidogrel. Patients treated with ticagrelor showed similar frequency with those in prasugrel group (OR = 0.86, 95% CI = 0.22 ~ 2.3, P > 0.05). No significant heterogeneity was observed across included studies.ConclusionsOur findings suggest that prasugrel and ticagrelor are more effective than clopidogrel on prevention of ST among patients underwent PCI. Simultaneously, there is no significant difference in the prevention of ST between prasugrel and ticagrelor.

Impact of mild therapeutic hypothermia on bioavailability of ticagrelor in patients with acute myocardial infarction after out-of-hospital cardiac arrest.

Out-of-hospital cardiac arrest (OHCA) frequently occurs in the early phase of acute myocardial infarction (MI). Survivors require percutaneous coronary intervention (PCI) with concomitant dual antiplatelet therapy. Target temperature management, including mild therapeutic hypothermia (MTH), should be applied in comatose patients after resuscitation. However, an increased risk of stent thrombosis in patients undergoing hypothermia is observed. The aim of this study was to assess the impact of MTH on pharmacokinetics of ticagrelor in cardiac arrest survivors with MI treated with MTH and PCI. In a prospective, observational, single-center study pharmacokinetics of ticagrelor were evaluated in 41 MI patients, including 11 patients after OHCA undergoing MTH (MTH group) and 30 MI patients without OHCA and MTH (no-MTH group). Blood samples were drawn before administration of a 180 mg ticagrelor loading dose, and 30 min, 1, 2, 4, 6, 12, and 24 h after the loading dose. In patients treated with MTH total exposure to ticagrelor during the first 12 h after the loading dose and maximal plasma concentration of ticagrelor were significantly lower than in the no-MTH group (AUC(0-12): 3403 ± 2879 vs. 8746 ± 5596 ng·h/mL, difference: 61%, p = 0.01; Cmax: 475 ± 353 vs. 1568 ± 784 ng/mL, p = 0.0002). Time to achieve maximal ticagrelor plasma concentration was also delayed in the MTH group (tmax for ticagrelor: 12 [6-24] vs. 4 [2-12] h, p = 0.01). Bioavailability of ticagrelor was substantially decreased and delayed in MI patients treated with MTH after OHCA. ClinicalTrials.gov Identifier: NCT02611934.

Anticoagulation reduces iliocaval and iliofemoral stent thrombosis in patients with cancer stented for nonthrombotic venous obstruction

ObjectiveTo identify factors associated with venous stent thrombosis in patients with cancer treated for nonthrombotic iliocaval or iliofemoral venous obstruction. MethodsWe performed a retrospective review of relevant imaging and medical records from 30 consecutive patients with cancer treated at a single center who underwent venous stent placement for nonthrombotic iliocaval or iliofemoral venous obstruction between 2008 and 2018. Follow-up imaging was used to assess stent patency. Variables examined included patient demographics, cancer type, stent characteristics, anticoagulant, and antiplatelet medications and complications of treatment. ResultsOverall primary stent patency was 83% (25/30). The median follow-up period was 44 days (range, 3-365 days). Ten percent of patients occluded owing to in-stent thrombosis and 7% owing to tumor compression of the stent without thrombosis. Therapeutic poststent anticoagulation with enoxaparin, warfarin, or a factor Xa inhibitor was initiated in 87% of the patients. Stent thrombosis occurred in one patient in the anticoagulation group (4%) at 50 days. Stent thrombosis occurred in two patients in the nonanticoagulation group (50%), one at 9 days and the other at 91 days. Anticoagulation was found to be protective against stent thrombosis in this population (hazard ratio, 0.015; P = .011). No statistically significant associations were found among the remaining variables. One patient in the anticoagulation group experienced major bleeding (1/26 [4%]). ConclusionsIliocaval and iliofemoral stent placement for nonthrombotic malignant venous obstruction is safe with favorable primary patency rates. Therapeutic anticoagulation is associated with less stent thrombosis in patients with cancer stented for nonthrombotic iliocaval and iliofemoral venous obstruction.

Outcomes After First- Versus Second-Generation Drug-Eluting Stent Thrombosis (from the REAL-ST Registry)

Limited data exist on the comparison of clinical outcomes after first- and second-generation drug-eluting stent (DES) thrombosis. From the Retrospective Multicenter Registry of Stent Thrombosis (ST) After First- and Second-Generation DES Implantation registry, this study evaluated 655 ST patients (first-generation DES thrombosis [G1-ST], n = 342; second-generation DES thrombosis [G2-ST], n = 313). After propensity score matching, the final study population consisted of 159 matched patients. The primary end point was the cumulative 1-year incidence of mortality. The mortality after G2-ST at 1 year was similar to that after G1-ST (23.0% vs 22.9%, p = 0.76). Also, the G2-ST group showed a significantly lower rate of target lesion revascularization than the G1-ST group (9.7% vs 17.1%, p = 0.01). Risk factors of 1-year mortality included cardiogenic shock or arrest at the time of ST, multivessel ST, left ventricular ejection fraction ≤40%, advanced age, and final thrombolysis in myocardial infarction flow grade ≤2. In conclusion, patients with G2-ST showed a similar 1-year mortality to those with G1-ST, highlighting that ST remains a life-threatening complication in the second-generation DES era.

One-year outcomes of patients undergoing complex percutaneous coronary intervention with three contemporary drug-eluting stents.

We aimed to evaluate the 1-year outcomes of three everolimus-eluting stents (EES) for complex percutaneous coronary intervention (PCI). It is controversial whether contemporary bioresorbable-polymer drug-eluting stents (BP-DES) are associated with better outcomes compared with durable-polymer DES (DP-DES). Patients undergoing PCI with cobalt-chromium (CoCr)-DP-EES (Xience), platinum-chromium (PtCr)-DP-EES (Promus), or PtCr-BP-EES (Synergy) at one high-volume institution between 2015 and 2017 were included. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target-vessel revascularization. Associations were also examined in patients undergoing complex PCI. Multivariable analysis was conducted to adjust for baseline differences across groups. We included n= 5,446 patients (CoCr-DP-EES, n= 3,177; PtCr-DP-EES, n= 1,555; PtCr-BP-EES, n= 714). Patients treated with PtCr-BP-EES had higher comorbidity burden and procedural complexity. At 1 year, MACE rates were 8.9% for CoCr-DP-EES versus 8.9% for PtCr-DP-EES versus 8.6% for PtCr-BP-EES (p= .97). The incidence of definite/probable stent thrombosis (ST) was also similar (0.6 vs. 0.4 vs. 0.3%, p= .69). Complex PCI was performed in n= 2,894/5,446 (53.1%). At 1 year, MACE rates were 11.5 versus 10.7 versus 10.3%, respectively (p= .83). The incidence of definite/probable ST was also similar (0.9 vs. 0.3 vs. 0.3%, p= .22). On multivariable analysis, stent type was not an independent predictor of MACE either in the overall or in the complex PCI population. We observed comparable 1-year rates of MACE and definite/probable ST in patients undergoing PCI with CoCr-DP-EES, PtCr-DP-EES, and PtCr-BP-EES. Results were unchanged among patients undergoing complex PCI. Future multicenter randomized studies should confirm and extend our findings.

ABBREVIATED DAPT FOLLOWED BY P2Y12 MONOTHERAPY AS COMPARED TO STANDARD DAPT POST-PCI: A SYSTEMATIC REVIEW AND META-ANALYSIS

At least 12 months of dual antiplatelet therapy [DAPT] after percutaneous coronary intervention [PCI] was recommended following reports of increased stent thrombosis in patients treated with first generation drug eluting stents [DES]. However in the present era of second generation and newer DES,