No abstract

To verify the frequency and predictors associated with stent thrombosis (ST) in a developing country. Observational, case-control study including 2535 consecutive patients undergoing percutaneous coronary intervention (PCI) in two reference hospitals in Brazil, from October 2013 to December 2015. ST patients were matched to controls in a 1:3 ratio for gender, age, procedure indication, and performing hospital. From the total sample, 65 (2.5%) ST occurred and were matched with 195 controls (age 64.9 ± 11.8 years; hypertension, 78.8%; diabetes, 30%). Clopidogrel and aspirin early withdrawal (OR 19.25; 95% CI 1.66-23.52; p < 0.01 and OR 4.36; 95% CI 1.81-10.50; p = 0.001, respectively), hypertension (OR 3.64; 95% CI 1.38-9.61; p = 0.006), dyslipidemia (OR 2.84; 95% CI 1.48-5.45; p = 0.002), smoking (OR 3.09; 95% CI 1.28-7.43; p = 0.02), body mass index ≥ 30 kg/m (OR 2.10; 95% CI 1.02-4.49; p = 0.012), previous myocardial infarction (OR 2.98; 95% CI 1.14-7.47; p < 0.001), bifurcation lesion (OR 2.44; 95% CI 1.05-5.67; p = 0.03), and ≥ 3 stents (OR 3.90; 95% CI 1.78-8.52; p = 0.002) were associated with ST. Stent type, diameter or length, severity of coronary artery disease, calcified lesions, and thrombus were not associated with ST. We found a similar frequency of ST from developed countries and identified strong predictors (clopidogrel and aspirin withdrawal, hypertension, dyslipidemia, smoking, obesity, previous myocardial infarction, bifurcation lesion, number of stents), which are in line with reports from developed countries.

Background: Individualized use of glycoprotein IIb/IIIa inhibitors during primary percutaneous coronary intervention in scenarios with high thrombotic load or occurrence of coronary flow abnormalities may be considered, despite scarce scientific evidence. Our objective was to compare patients undergoing primary percutaneous coronary intervention treated or not with glycoprotein IIb/IIIa inhibitors during the procedure. Methods: A national, multicenter, retrospective study that included consecutive patients undergoing primary percutaneous coronary intervention, treated or not with glycoprotein IIb/IIIa inhibitors, between June 2006 and March 2016, using the database of the Central Nacional de Intervenções Cardiovasculares (CENIC). Results: We enrolled 18,690 patients, of which 3,032 (16.2%) received glycoprotein IIb/IIIa inhibitors. The mean age was 61.5±12.4 years, 69.5% were men, and 19.9% had diabetes mellitus. The group receiving glycoprotein IIb/IIIa inhibitors had a higher prevalence of long, thrombotic, bifurcation lesions, occlusions or TIMI flow grade <2. This group showed higher mortality (3.7% vs. 4.8%; p=0.0046), reinfarction (0.5% vs. 1.1%; p<0.0001) and major adverse cardiac event rates (4.0% vs. 5.7%; p<0.0001). In the univariate analysis, the use of glycoprotein IIb/IIIa inhibitors was associated with a higher chance of death (RR 1.31; 95%CI 1.09-1.58; p=0.0048), but was not confirmed as an independent predictor in the multivariate analysis. Conclusion: Among patients undergoing primary percutaneous coronary intervention, the group treated with glycoprotein IIb/IIIa inhibitors had greater clinical severity and anatomical complexity, and worse in-hospital clinical outcomes.

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