Methods
A cohort of 2775 patients treated with DES (1079 presenting with ACS and 1696 stable patients) and were followed clinically up to 1 year and clinical events were recorded and compared between the two groups. Patients who received a bare metal stent were excluded. Only patients with definitive ST were included in our analysis. Our data was restricted to those who had at least 1 year follow-up.
Methods
A cohort of 2775 patients treated with DES (1079 presenting with ACS and 1696 stable patients) and were followed clinically up to 1 year and clinical events were recorded and compared between the two groups. Patients who received a bare metal stent were excluded. Only patients with definitive ST were included in our analysis. Our data was restricted to those who had at least 1 year follow-up.
Results
ACS patients were sicker at presentation. Sixty-five percent of ACS patients had myocardial infarction on admission. ACS patients were more likely to be younger, female, African American, have renal insufficiency, have history of MI, have more diseased vessels, have a longer hospital stay, and have higher use of heparin and glycoprotein IIb/IIIa inhibitors. In-hospital complications and major bleeding were more likely in the ACS group. However, subacute stent thrombosis was similar in both groups. At 1 and 6 months and up to 1 year, ST trends toward significance in the ACS group. At 2 years, ST becomes significantly higher in the ACS group. Late ST contributed to the significant increase in cumulative ST in the ACS group at 6 months, 1 year, and 2 years despite a high clopidogrel compliance rate.
Conclusions
Patients presenting with ACS who are undergoing PCI with DES have higher ST rates compared to stable patients at 2 years. There is a continued trend toward higher ST rates at every time point. Patients with ACS who are treated with DES should take extra caution with prolonged dual antiplatelet therapy to prevent late ST events.
Rates of ST in ACS vs. stable patients treated with DES
| ACS ( n =1079) | Stable ( n =1696) | P value | |
|---|---|---|---|
| In-hospital outcomes ( N =2775) | |||
| Major complications (death, QWMI, CABG) | 10/1079 (0.9% ) | 5/1696 (0.3%) | .027 |
| Subacute ST | 3/1079 (0.3%) | 1/1696 (0.1%) | .306 |
| Major bleeding (GI, Hct >15, hematoma >4 cm) | 44/1077 (5.2%) | 7/1693 (0.4%) | <.001 |
| Long-term outcomes | |||
| 1-year MACE (death, QWMI, TVR) | 187/1079 (17.3%) | 161/1697 (9.5%) | <.001 |
| Stent thrombosis | |||
| ST at 30 days | 12/1079 (1.1%) | 8/1696 (0.5%) | .052 |
| ST at 6 months | 15/1079 (1.4%) | 11/1697 (0.6%) | .048 |
| Late ST at 6 months | 3/1079 (0.3%) | 3/1697 (0.2%) | .683 |
| ST at 1 year | 16/1079 (1.5%) | 13/1697 (0.8%) | .07 |
| Late ST at 1 year | 4/1079 (0.4%) | 5/1697 (0.3%) | .742 |
| ST at 2 years | 22/793 (2.8%) | 14/1249 (1.1%) | .006 |
| Late ST at 2 years | 10/793 (1.3%) | 6/1249 (0.5%) | .051 |
| Clopidogrel compliance at 1 year | 83.03% | 79.29% | .257 |
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