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Stent thrombosis is a most devastating event that occurs after percutaneous coronary intervention (PCI), which can lead to large myocardial infarction and death. In randomized trial, newer generation drug-eluting stent and newer antiplatelet therapy have shown to lower the incidence of stent thrombosis. The aim of our study was to describe the pattern of the patients who presented with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis in our real-world practice.
This is a single-center retrospective study of 527 patients who presented with STEMI from 2007 to early 2014. The treatment strategy was at the discretion of the treating physician. Stent thrombosis (ST) was defined based on the angiographic finding (definite ST). Clinical and procedural characteristics were compared between the patients with and without ST. The detailed information for patients with ST regarding the type of previous stent, timing of event, and the use of dual antiplatelet therapy (DAPT) were reviewed.
Among 527 patients with STEMI, 57 patients (11%) had angiographically confirmed stent thrombosis. The prevalence of hypertension, diabetes mellitus, dyslipidemia were higher in patients with ST than patients without ST. Patients with ST had higher median CPK (CPK 2319 vs 1508) and lower left ventricular function (37 + 5% vs 44 + 16%), but there was no difference in in-house mortality (2% vs 4%). ST occurred early (<1 month) in 30%, and very late (>1 year) in 56%. The previous stents were bare-metal stent in 19%, 1st generation drug-eluting stent in 33%, and 2nd generation drug-eluting stent in 40%. 48% of patients were taking DAPT (100% of acute ST, 79% of subacute ST, 38% of late ST, and 19% of very late ST). Premature cessation of DAPT was seen only in 12%. In 12% of patients, DAPT was held by the physician for procedures.
In our cohort of patients, ST was a cause for STEMI in 11% of patients. Patients who presented with ST had more comorbidity, but in-house mortality was similar to non-ST patients. ST was seen in variety of clinical setting regarding the timing, the previous stent, and the concomitant DAPT use. ST is rare but continue to exist in current era.