Incidence, Implications, and Predictors of Stent Thrombosis in Acute Myocardial Infarction

Acute Coronary Stent Thrombosis in Modern Era: Etiology, Treatment, and Prognosis

“…EUROMAX trial confirmed that patients with AST were more likely to have procedural complications (21.4 vs. 6.6%, p = 0.03); right coronary artery interventions (64.3 vs. 43.7%, p = 0.12); less hypertension (14.0 vs. 44.0%, p = 0.03); and more likely to have received glycoprotein IIb/IIIa inhibitors (78.6 vs. 40.3%, p = 0.004) versus those without AST [1]. Heestermans et al [2] and Lim et al [8] revealed that the following factors were the independent predictors of AST: prior MI, anemia, decreased left ventricular ejection fraction, post-procedural uncovered dissection, the use of DES, bifurcation stenting, undersize/small stent diameter (mean stent diameter <3.0 mm), no glycoprotein IIb/IIIa inhibitors therapy, no reflow, post-procedural TIMI flow <3, flow limiting stenosis >50% proximal of the culprit lesion left untreated, severe calcification and multi-vessel. Post-procedural uncovered dissection, under-sizing, and small stent diameter were also associated with AST.…”

“…In the Dutch stent thrombosis registry, the occurrence of AST of BMS was 0.6% (32 out of 21,009 patients) [19]. Multiple registries and randomized trials with broad inclusion criteria showed that the rate of AST was similar post BMS and drug-eluting stent (DES) implantation (0.1-1.7%) [1,2,6,8,16,22]. It is to be noted that the prevalence of AST is lower for the newer generation DES due to the upgrade of DES and more efficient anticoagulants and anti-platelet treatment.…”

“…ST is defined by Academic Research Consortium classification as follows (Table 1): AST refers to thrombosis that occurred 0-24 h after stent implantation, including intra-procedural ST (IPST, during the procedure); sub-acute ST refers to ST that occurred between 24 h and <30 days after stent implantation; late ST refers to thrombosis that occurred between 30 days and 1 year after stent implantation; very late ST refers to thrombosis that occurred >1 year after stent implantation [8]. Definite ST is considered to have occurred by either angiographic or pathologic confirmation; probable ST is considered to have occurred after intracoronary stenting in the following cases: (1) any unexplained death within the first 30 days following intracoronary stenting and (2) documented acute ischemia in the territory of the implanted stent without angiographic confirmation of stent thrombosis and in the absence of any other obvious cause, irrespective of the time after the index procedure any MI [18].…”

“…In the past few years, the incidence of AST decreased to <1% due to the development of new therapeutic strategies and better understanding of the pathophysiology and predictive factors of thrombosis [8,14,15]. However, AST still remains a clinical challenge due to the catastrophic consequences.…”

“…Massive chest pain, shortness of breath, loss of consciousness and eventually, heart attack are the typical symptoms of AST. The incidence of AST varies between 0.1 and 1.7% [1,2,3,4,5,6,7,8]. The clinical consequences of AST are severe and could result in up to 50-80% acute myocardial infarction (MI) and >45% mortality [8,9,10,11].…”