Factors Impacting Stent Thrombosis in Patients With Percutaneous Coronary Intervention and Coronary Stenting: A Systematic Review and Meta-Analysis

Abstract

Stent thrombosis (ST) is a frequently reported complication in cardiac patients with percutaneous coronary intervention (PCI) that adversely impacts their prognostic outcomes. Medical literature reveals several baseline characteristics of PCI patients that may predict their predisposition to ST and its potential complications. Our systematic review and meta-analysis aimed to determine the diagnostic significance of these baseline parameters in terms of determining the risk of ST among adult patients with PCI. We statistically evaluated 18 baseline characteristics of more than 15,500 PCI patients to delineate their stent thrombosis attribution. We included a number of articles focusing on baseline parameters in-stent thrombosis-related PCI scenarios. We explored the articles of interest based on inclusion/exclusion parameters across PubMed, JSTOR, Cochrane library, Google Scholar, and Embase. Medical subject headings (MeSH) words included “stent thrombosis,” “percutaneous coronary intervention,” and “coronary stenting.” We extracted the research articles published between 2005 and 2021 on April 20, 2021. The included studies also focused on procedures and clinical factors concerning their association with PCI-related ST. Our findings ruled out the progression of abnormal left ventricular ejection fraction (LVEF)-related stent thrombosis in PCI patients (odds ratio {OR}: 9.68, 95% CI: 1.88-49.90, p=0.007). We found an insignificant clinical correlation between stent thrombosis and PCI in the setting of acute coronary syndrome (ACS). Our study outcomes further revealed the absence of stent thrombosis in PCI patients with antiplatelet prescription (OR: 32.42, 95% CI: 21.28-49.39). The findings affirmed the absence of ST in PCI patients receiving aspirin therapy (OR: 32.77, 95% CI: 18.73-57.34; OR: 4.59, 95% CI: 1.97-10.73). The majority of the included studies negated the clinical correlation of stent thrombosis with diabetes mellitus in the setting of PCI (OR: 0.49, 95% CI: 0.06-3.78). Our study did not reveal statistically significant results based on stent thrombosis in PCI patients with drug-eluting stents (OR: 2.91, 95% CI: 0.35-24.49). The findings also did not reveal the impact of cardiac biomarker elevation on stent thrombosis in PCI patients (OR: 8.42, 95% CI: 2.54-27.98, p=0.0005). Eight studies revealed a statistically insignificant correlation between myocardial infarction and stent thrombosis in PCI scenarios (OR: 2.69, 95% CI: 0.89-8.11, p=0.08). The clinical correlation between PCI and stent thrombosis/major bleeding in the setting of hypertension also proved statistically insignificant at 0.67 (OR: 1.31, 95% CI: 0.38-4.51, p=0.97). The study findings did not correlate mean body mass index and multivessel coronary artery disease with ST in PCI scenarios (OR: 1.98, 95% CI: 0.02-239.58, p=0.78; OR: 1.09, 95% CI: 0.58-2.04, p=0.80). Only two studies revealed statistically significant results confirming stent thrombosis in PCI patients with a prior history of PCI (OR: 0.49, 95% ...

Frequency of Early Stent Thrombosis (Acute and Subacute) in Patients Presenting With Acute St Elevation Myocardial Infarction (Stemi) Undergoing Primary Percutaneous Coronary Intervention (Pci)

“…These early occurrences are thought to be caused by various procedural variables and lesion-related characteristics, either separately or in combination, such as stent underexpansion, tissue protrusion, residual thrombus, edge dissection, and impaired flow. (8)(9)(10). 'In our study,' the incidence of early stent thrombosis ('ST'), comprising 'acute or sub-acute' occurrences after primary percutaneous coronary intervention ('PCI'), was 5.8%.…”

Magnesium bioresorbable scaffold (Magmaris) versus polymer biodegradable ultrathin drug-eluting stent (Ultimaster) in acute coronary syndrome. Mid-term outcomes (2 years)

“…Moreover, the higher strut thickness of the BRS compared to metallic DES may be beneficial in the process of thrombus entrapment under the struts after scaffold implantation, and it may be reflected in the reduction of the distal flow impairment [ 41 – 43 ]. On the other hand, the ACS subset per se increases stent thrombosis rates [ 44 ]. This, combined with the previously described trend toward higher scaffold thrombosis rates with first-generation BRS [ 9 , 45 , 46 ], may negate any theoretical benefit of BRS.…”

An Uncommon Case of Acute Coronary Stent Thrombosis

“…DAPT relies on the synergy of cyclooxygenase-1 inhibitors (aspirin) and P2Y12 receptor inhibitors (clopidogrel, prasugrel, or ticagrelor) to prevent clot formation [ 7 ]. The length of DAPT depends on the stability of ischemic heart disease, the type of stent used, and the bleeding risk.…”