TY - JOUR
T1 - Intra-procedural stent thrombosis
T2 - A new risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention for acute coronary syndromes
AU - Brener, Sorin J.
AU - Cristea, Ecaterina
AU - Kirtane, Ajay J.
AU - McEntegart, Margaret B.
AU - Xu, Ke
AU - Mehran, Roxana
AU - Stone, Gregg W.
N1 - Funding Information:
Dr. Mehran has served as consultant to Abbott, AstraZeneca, Ortho McNeil, and Regado; and has received research grant support from Sanofi/BMS and the Medicines Company . Dr. Stone has received consulting fees from Medtronic, GlaxoSmithKline, Eli Lilly, and Bristol-Myers Squibb and grant support from Boston Scientific , the Medicines Company , and Abbott Vascular . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2013/1
Y1 - 2013/1
N2 - Objectives: The aim of this study was to examine the incidence, correlates, and consequences of intra-procedural stent thrombosis (IPST) in patients with acute coronary syndromes (ACS). Background: Stent thrombosis (ST) is a rare but serious complication of percutaneous coronary intervention (PCI). The Academic Research Consortium definition of ST excludes events occurring during PCI. Methods: Angiograms from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) and HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trials were reviewed frame-by-frame at an independent core laboratory for the occurrence of IPST. Patients with versus without IPST were compared to identify baseline characteristics associated with IPST and demonstrate the independent association between IPST and adjudicated events at 30 days and 1 year. Results: Intra-procedural ST occurred in 47 (0.7%) of 6,591 patients. The occurrence of IPST was associated with ST-segment elevation myocardial infarction presentation, high white blood cell count, treatment of thrombotic and bifurcation lesions, bivalirudin monotherapy, bail-out IIb/IIIa inhibitor use, and implantation of bare-metal (rather than drug-eluting) stents. Major adverse ischemic events were markedly higher in patients with versus without IPST, including mortality at 30 days (12.9% vs. 1.4%, p < 0.0001) and 1 year (12.9% vs. 3.1%, p < 0.0001). Out-of-lab Academic Research Consortium definite or probable ST also occurred significantly more often among IPST patients at 30 days (17.4% vs. 1.8%, p < 0.0001) and 1 year (19.9% vs. 2.7%, p < 0.0001). Intra-procedural ST was a significant independent predictor of 1-year mortality (hazard ratio: 3.86, 95% confidence interval: 1.66 to 9.00, p = 0.002). Conclusions: Intra-procedural ST is a relatively rare complication of PCI in ACS but is strongly associated with subsequent out-of-lab ST and mortality. Intra-procedural ST should be considered as a distinct category of ST and routinely reported, particularly for ACS patients.
AB - Objectives: The aim of this study was to examine the incidence, correlates, and consequences of intra-procedural stent thrombosis (IPST) in patients with acute coronary syndromes (ACS). Background: Stent thrombosis (ST) is a rare but serious complication of percutaneous coronary intervention (PCI). The Academic Research Consortium definition of ST excludes events occurring during PCI. Methods: Angiograms from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) and HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trials were reviewed frame-by-frame at an independent core laboratory for the occurrence of IPST. Patients with versus without IPST were compared to identify baseline characteristics associated with IPST and demonstrate the independent association between IPST and adjudicated events at 30 days and 1 year. Results: Intra-procedural ST occurred in 47 (0.7%) of 6,591 patients. The occurrence of IPST was associated with ST-segment elevation myocardial infarction presentation, high white blood cell count, treatment of thrombotic and bifurcation lesions, bivalirudin monotherapy, bail-out IIb/IIIa inhibitor use, and implantation of bare-metal (rather than drug-eluting) stents. Major adverse ischemic events were markedly higher in patients with versus without IPST, including mortality at 30 days (12.9% vs. 1.4%, p < 0.0001) and 1 year (12.9% vs. 3.1%, p < 0.0001). Out-of-lab Academic Research Consortium definite or probable ST also occurred significantly more often among IPST patients at 30 days (17.4% vs. 1.8%, p < 0.0001) and 1 year (19.9% vs. 2.7%, p < 0.0001). Intra-procedural ST was a significant independent predictor of 1-year mortality (hazard ratio: 3.86, 95% confidence interval: 1.66 to 9.00, p = 0.002). Conclusions: Intra-procedural ST is a relatively rare complication of PCI in ACS but is strongly associated with subsequent out-of-lab ST and mortality. Intra-procedural ST should be considered as a distinct category of ST and routinely reported, particularly for ACS patients.
KW - ACS
KW - PCI
KW - intra-procedural
KW - outcome
KW - stent thrombosis
UR - http://www.scopus.com/inward/record.url?scp=84872798975&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2012.08.018
DO - 10.1016/j.jcin.2012.08.018
M3 - Article
C2 - 23266233
AN - SCOPUS:84872798975
SN - 1936-8798
VL - 6
SP - 36
EP - 43
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 1
ER -