Outcomes of Drug-Eluting Stent Thrombosis After Treatment for Acute Versus Chronic Coronary Syndrome

JACC Cardiovasc Interv. 2021 May 24;14(10):1082-1090. doi: 10.1016/j.jcin.2021.03.051.

Abstract

Objectives: The primary objective of the current analysis was to assess the association between the clinical presentation at index procedure and mortality in patients with second-generation drug-eluting stent thrombosis (G2-ST).

Background: Patients with acute coronary syndrome (ACS) have a higher risk for stent thrombosis (ST) as compared with those with chronic coronary syndrome (CCS). However, clinical outcomes of patients with G2-ST after treatment for ACS and CCS remain poorly understood.

Methods: From the REAL-ST (Retrospective Multicenter Registry of ST After First- and Second-Generation Drug-Eluting Stent Implantation) registry, this study evaluated 313 patients with G2-ST. According to baseline clinical presentation, patients were divided into the 2 groups: the ACS and CCS groups (n = 147 and n = 166, respectively). The primary endpoint was the cumulative 3-year incidence of all-cause death after the index ST events. Timing of ST, target lesion revascularization, and recurrent ST were also assessed.

Results: Early ST was more frequently observed in the ACS group (71.4% vs. 44.6%), while very late ST was less likely to occur in the ACS group than in the CCS group (11.6% vs. 30.7%). Cumulative 3-year incidence of all-cause death after the index ST events was comparable between the ACS and CCS groups (28.6% vs. 28.3%; hazard ratio: 1.14; 95% confidence interval: 0.75 to 1.73; p = 0.55). Compared with the CCS group, the ACS group showed higher incidences of target lesion revascularization and recurrent ST (23.8% vs. 17.2%; p = 0.06; and 9.9% vs. 1.4%; p = 0.001, respectively).

Conclusions: Patients with G2-ST were associated with higher mortality irrespective of baseline clinical presentation.

Keywords: acute coronary syndrome; chronic coronary syndrome; drug-eluting stent; stent thrombosis.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Coronary Syndrome* / diagnostic imaging
  • Acute Coronary Syndrome* / therapy
  • Coronary Thrombosis* / diagnostic imaging
  • Coronary Thrombosis* / etiology
  • Drug-Eluting Stents*
  • Humans
  • Percutaneous Coronary Intervention* / adverse effects
  • Retrospective Studies
  • Thrombosis*
  • Time Factors
  • Treatment Outcome