Time course, predictors and clinical implications of stent thrombosis following primary angioplasty

Giuseppe De Luca; Maurits T. Dirksen; Christian Spaulding; Henning Kelbæk; Martin Schalij; Leif Thuesen; Bas van der Hoeven; Marteen A. Vink; Christoph Kaiser; Carmine Musto; Tania Chechi; Gaia Spaziani; Luis Salvador Diaz de la Llera; Vincenzo Pasceri; Emilio Di Lorenzo; Roberto Violini; Harry Suryapranata; Gregg W. Stone; for the DESERT cooperation

doi:10.1160/TH13-02-0092

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2013; 110(04): 826-833
DOI: 10.1160/TH13-02-0092

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Time course, predictors and clinical implications of stent thrombosis following primary angioplasty

Insights from the DESERT cooperation

Giuseppe De Luca

¹Division of Cardiology, Ospedale “Maggiore della Caritá”, Eastern Piedmont University, Novara, Italy

²Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy

,

Maurits T. Dirksen

³Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

,

Christian Spaulding

⁴European Hospital Georges Pompidou, Assistance Publique-Hopiteaux de Paris and INSERM U 970, Paris Descartes University, Paris, France

,

Henning Kelbæk

⁵The Heart Center, Rigshospitalet, Copenhagen, Denmark

,

Martin Schalij

⁶Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

,

Leif Thuesen

⁷Cardiac Department, Skejby Hospital, Skejby, Denmark

,

Bas van der Hoeven

⁶Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

,

Marteen A. Vink

³Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

,

Christoph Kaiser

⁸Department of Cardiology, University Hospital Basel, Switzerland

,

Carmine Musto

⁹Division of Cardiology, San Camillo Hospital, Rome Italy

,

Tania Chechi

¹⁰Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy

,

Gaia Spaziani

¹⁰Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy

,

Luis Salvador Diaz de la Llera

¹¹Hemodynamics and Interventional Cardiology Unit, University Hospital Virgen del Rocio, Seville, Spain

,

Vincenzo Pasceri

¹²Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy

,

Emilio Di Lorenzo

¹³Division of Cardiology, “S.G. Moscati”, Avellino, Italy

,

Roberto Violini

⁹Division of Cardiology, San Camillo Hospital, Rome Italy

,

Harry Suryapranata

¹⁴Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands

,

Gregg W. Stone

¹⁵Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York, USA

,

for the DESERT cooperation

› Institutsangaben

Abstract

summary

Primary percutaneous coronary intervention (pPCI) has improved survival as compared to thrombolysis. Concerns still remain regarding the risk of stent thrombosis in the setting of STEMI, especially after drugeluting stent (DES) implantation. Therefore, the aim of this study was to report on the timing of stent thrombosis (ST) with both DES and bare metal stents (BMS) and its prognostic significance in patients undergoing pPCI. The Drug-Eluting Stent in Primary Angioplasty (DESERT) cooperation is based on a pooled database including individual data of randomised trials that evaluate the long-term safety and effectiveness of DES as compared to BMS in patients undergoing pPCI for STEMI. Follow-up data were collected for 3–6 years after the procedure. ST was defined as definite or probable, based on the ARC definition. The study population consists of 6,274 STEMI patients undergoing primary angioplasty with BMS or DES. At 1201±440 days, ST occurred in 267 patients (4.25%). Most of the events were acute or subacute (within 30 days) and very late (> 1 years), with different distribution between DES vs BMS. Patients with ST were more often diabetic (21.7% vs 15.1%, p=0.005), more frequently had post-procedural TIMI 0–2 flow (14.0% vs 9.3%, p = 0.01), and were less often treated with dual antiplatelet therapy at one year follow-up. Diabetes (p = 0.036), post-procedural TIMI 0–2 Flow (p = 0.013) and ischaemia time > 6 hours (p = 0.03) were independent predictors of ST. Post-procedural TIMI 0–2 flow (p = 0.001) and ischaemia time > 6 hours (p < 0.001) were independent predictors of early ST, ischaemia time > 6 hours (p=0.05) was independent predictor of late ST, whereas diabetes (p = 0.022) and use of DES (p=0.002) were independent predictors of very late ST. ST was associated with a significantly higher mortality (23.6% vs 6%, p < 0.001). The greatest impact on mortality was observed with subacute (40.4%) and late (20.9%) ST, as compared to acute (12.5%) and very late (9.1%) ST. ST was an independent predictor of mortality (HR [95%CI]=3.73 [2.75–5.07], p < 0.001). In conclusion, ST occurs relatively frequently also beyond the first year for up to six years after pPCI in STEMI, with higher late occurrence rates among patients treated with first generation DES. ST after pPCI is a powerful predictor of mortality, especially subacute ST.

Keywords

Acute myocardial infarction - thrombosis - clinical studies

Volltext

Referenzen

References
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