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Stent thrombosis after PCI rare, but associated with worse outcomes

24 Oct 2020

Despite advancements in stents and medication, stent thrombosis (ST) continues to occur in rare occasions following percutaneous coronary intervention (PCI), a recent study has shown. In turn, ST amplifies mortality in these patients.

The study included 41,137 patients (mean age, 66.0±11.9 years; 23.5 percent female) who underwent PCI. ST was defined according to the criteria of the Academic Research Consortium, and its impacts on 30-day outcomes—such as all-cause mortality, major bleeding, emergency PCI, and new stroke—was assessed.

Over the 5-year study period, only 225 definite and probable STs were detected, yielding a small incidence rate of 0.55 percent.

Patients who developed ST were less likely to have received drug-eluting stents (p=0.01) but were more likely to have undergone PCI to lesions in the left anterior descending or left main arteries (p=0.03 overall for lesion location). Dual antiplatelet therapy was also less common among ST patients (p<0.01), who were more frequently discharge without any antiplatelet medication (p<0.001).

In terms of outcomes, ST correlated with a 23.6-percent mortality rate at 30 days. In comparison, those without ST only saw a corresponding rate of 1.1 percent (p<0.001).

Major bleeding likewise occurred significantly more frequently in ST patients (8.4 percent vs 1.1 percent; p<0.001), as did emergent PCI or coronary artery bypass grafting procedures (20.0 percent vs 4.0 percent; p<0.001).

“The results of this registry-based study of a large cohort of unselected patients undergoing PCI suggest that, even with new generation stent technology and adjunctive medication, ST occurs following approximately 1 in every 200 PCIs. In the contemporary setting, ST is associated with increased risk of mortality at 30 days,” researchers said.

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