Long‐Term Outcomes and Clinical Predictors of Mortality Following Occurrence of Stent Thrombosis

Abstract

Background Stent thrombosis (ST) remains a significant medical issue. In particular, longer‐term mortality and clinical predictors after ST occurrence have yet to be elucidated. Methods and Results This was a multicenter, retrospective, observational study. A total of 187 definite ST cases from January 2008 to December 2017 were enrolled, and the long‐term clinical outcomes were investigated. The primary outcome measure was the cumulative mortality after ST occurrence. In addition, independent predictors of mortality were assessed. Among the stent types causing ST, bare‐metal stent, first‐generation drug‐eluting stent, second‐generation drug‐eluting stent, and third‐generation drug‐eluting stent comprised 31.0%, 19.3%, 36.9%, and 6.4% of cases, respectively. Median duration from stent implantation to ST was 680.5 (interquartile range, 33.8–2450.5) days. Cumulative mortality was 14.6%, 17.4%, 21.2%, 24.4%, and 33.8% at 1, 2, 3, 5 and 10 years, respectively. The cumulative mortality did not significantly differ by type of stent, and mortality of late ST was higher than that of early ST and very late ST; however, it did not reach statistical significance after the multivariate analysis. Independent predictors of mortality were hemodialysis (hazard ratio [HR], 7.80; 95% CI, 3.07–19.81; P <0.001), culprit lesions in the left main trunk (HR, 8.14; 95% CI, 1.71–38.75; P =0.008), culprit lesions in the left coronary artery (HR, 2.77; 95% CI, 1.10–6.96; P =0.030), and peak creatine kinase (HR, 1.017; 95% CI, 1.011–1.022; P <0.001). Conclusions The 10‐year cumulative mortality after ST reached 33.8%. Close follow‐up is thus mandatory for patients with ST, especially with hemodialysis, culprit lesions in the left main trunk and left coronary artery, and high peak creatine kinase.

Akut koroner sendromda akut stent trombozunun ve hastane içi mortalitenin yeni bir inflamasyon göstergesi: çoklu inflamasyon indeksi

“…This study was also the first to evaluate the relationship between MII and in-hospital mortality in ACS patients. The rate of in-hospital mortality in the acute ST group was consistent with the higher cumulative mortality rate reported in previous studies (2)(3)(4). The cut-off value of MII-3 for predicting acute ST was associated with a higher risk of mortality.…”

“…Acute stent thrombosis (ST) is a catastrophic complication that occurs following PCI and is associated with myocardial infarction and sudden cardiac death (2). Its incidence is about 2.4% and has a mortality rate of up to 34% (2,3). Acute ST processing may occur depending on the patient, lesion, stent characteristics, and efficacy of antiaggregant treatment.…”

Metal free percutaneous coronary interventions in all-comers: First experience with a novel sirolimus-coated balloon

“…Nowadays, drug-eluting stents (DES) represent the gold standard device used for treatment of the majority of de-novo coronary artery lesions [1]. Despite technical advancements and improved medical therapy, in-stent restenosis (ISR) and very late stent thrombosis (ST) remain a concern, even with the latest generation of DES [2,3]. Recent reports have indicated an annual stent failure rate up to 2%, especially in complex and long lesions [4][5][6][7].…”

Coronary Stent Thrombosis and Mortality: Does the Relationship Stand the Test of Time?

“…In this issue of the Journal of the American Heart Association ( JAHA ), Ishihara et al 4 report the findings of a multicenter retrospective observational registry study of patients with stent thrombosis. During the years 2008 to 2017, they identified 187 patients with Academic Research Consortium definite stent thrombosis diagnosed at the time of coronary angiography.…”

“…But what are the determinants of overall mortality after stent thrombosis? A detailed look at the Kaplan‐Meier curves (Ishihara et al 4 Fiigures 2 and 4B) shows that the cumulative cardiac mortality increases abruptly in the early period following stent thrombosis but appears to increase only slightly beyond 2 years, which indicates that the longer‐term mortality is mainly related to other noncardiac causes. In fact, there was no occurrence of cardiac death beyond 5 years.…”