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Stent thrombosis is one of the most devastating adverse events following percutaneous coronary intervention. Stent thrombosis has been reported to account for about 7% cases of ST elevation myocardial infarction in contemporary practice and was associated with worse outcomes. In contrast, there are limited data about non-ST elevation myocardial infarction (NSTEMI) resulting from stent thrombosis. Therefore, we aimed to evaluate the prevalence and outcomes of NSTEMI due to stent thrombosis.
We performed a retrospective analysis of 481 consecutive patients with NSTEMI who underwent coronary angiography within five days after presentation. Stent thrombosis was defined according to the Academic Research Consortium criteria. Infarct size was measured as the peak cardiac troponin I (cTnI) value and a large myocardial infarction (MI) was defined as a peak cTnI greater than 90th percentile of the study population. Clinical and angiographic characteristics, the incidence of a large MI and in-hospital and 30-day major adverse cardiac event (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were compared between patients with and without stent thrombosis.
Among 481 patients, 18 (3.7%) patients had angiographically confirmed stent thrombosis. There was no significant difference in baseline characteristics. At the time of the events, ten patients with stent thrombosis were taking dual antiplatelet therapy. There was a trend toward higher peak troponin values in patients with stent thrombosis (median [interquartile range]; 3.41 [0.15-47.6] ng/ml vs. 0.68 [0.10-5.17] ng/ml, p=0.13). Patients with stent thrombosis had a higher incidence of large MI (27.8% vs. 9.3%, p=0.03). There was no significant difference in the rate of multivessel disease, left anterior descending artery culprit lesion and in-hospital revascularization. Among patients who underwent ad-hoc percutaneous coronary intervention, patients with stent thrombus had a higher rate of post-procedural TIMI grade 0 flow (20.0% vs. 1.9%, p=0.03). Patients with stent thrombosis had a higher incidence of in-hospital MACE (11.1% vs. 1.3%, p=0.03) and 30-day MACE (16.7% vs. 4.1%, p=0.04).
Stent thrombosis accounted for 3.7% cases of NSTEMI in this cohort of patients. Our study showed that patients with NSTEMI resulting from stent thrombosis had a higher rate of large MI, in-hospital and 30-day MACE.