Abstract
Background
Stent thrombosis (ST) is rare, but is associated with significant morbidity and mortality.
Methods
We analyzed data from the British Columbia (BC) Registry from April 2011–January 2012.
Results
101 ST cases were reported and verified. Based on timing, ST was considered early (≤ 30 days) in 35.6%, late (> 30 days–1 year) in 17.8% and very late (> 1 year) in 46.5%. The majority (68.5%) presented with STEMI, and the remaining with non-STEMI (31.5%). Most vessels were functionally occluded (TIM1 flow grade ≤ 1 in 67.1%). Thrombus burden was high (TIMI thrombus grade ≥ 4 in 77.2%). Aspiration thrombectomy was performed in 41% of cases. New stents were implanted in 62.4% cases. Intra-coronary imaging was low (11%). At the original stent implantation, STEMI was the clinical presentation in 39.6%, the lesion was complex in 62.1%, and thrombus was visualized in 23.0%. Prognosis after ST was unfavorable with high mortality (11.9% at 30 days and 16.8% at one year), and further revascularization (5.0% repeat PCI and 6.9% coronary artery bypass graft surgery). Early ST was associated with worse clinical outcome compared to late/very late ST: 30-day mortality at 22.2% versus 6.2% (p = 0.02), and 1-year mortality at 27.8% versus 10.8% (p = 0.05).
Conclusions
In this prospective registry from BC, all ST presented with myocardial infarction, and the majority was treated with emergency PCI. Additional stents were commonly implanted with infrequent use of intracoronary imaging. Mortality rate was higher for early ST in comparison with late/very late ST. A comprehensive approach should be developed to treat this difficult complication.
Highlights
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This study provides a contemporary view of stent thrombosis in British Columbia, Canada.
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Additional stents are commonly used to treat stent thrombosis with a low use of intracoronary imaging.
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Mortality rate is higher for early stent thrombosis in comparison with late or very late stent thrombosis.
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A tailored comprehensive approach should be developed to treat this difficult complication.
1
Introduction
Intra-coronary ST is a low frequency event, reported to occur in 1% of patients within the first 30 days following PCI, 0.6% per year in the subsequent years for the first-generation drug eluting stents, and 0.2% per year for the newer second-generation stents . This condition is associated with a poor prognosis with mortality rates approaching 18% during the index hospitalization and 25% at 1 year . ST is also associated with significant morbidity with more frequent repeat PCI or coronary artery bypass graft surgery (CABG). Several studies have identified a number of clinical, pharmacologic, angiographic, and procedural risk factors for ST. Recognition of such risk factors should help prevent ST and optimize treatment. Published literature suggests significant variation in the management of patients with ST between centers and operators. The real-world data from the BC province registry provides a cross-sectional view regarding epidemiology, risk factors and management in patients with ST in the contemporary era.
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