Incidence and Predictors of Stent Thrombosis in Patients Treated with Stents for Coronary Bifurcation Narrowing (From the BIFURCAT Registry)

https://doi.org/10.1016/j.amjcard.2021.06.031Get rights and content

Percutaneous coronary interventions performed at coronary bifurcations yield high rates of stent thrombosis (ST). The aim of the present study was to investigate the predictors of ST in contemporary coronary bifurcation percutaneous coronary interventions. We retrospectively investigated the BIFURCAT (comBined Insights From the Unified RAIN and COBIS bifurcAtion regisTries) registry on coronary bifurcations to assess the incidence and predictors of definite ST, which were the study primary endpoints. Predictors of ST among patients on dual antiplatelet therapy (DAPT) were also examined. A total of 5330 patients were included. After a mean 2-years follow-up, 64 (1.2%) patients experienced ST. 42 (65.6%) ST patients were on DAPT. At multivariable analysis, age (HR 1.02, CI 1.01 to 1.05, p = 0,027), smoking status (HR 2.57, CI 1.49 to 4.44, p = 0.001), chronic kidney disease (HR 2.26, CI 1.24 to 4.12, p = 0.007) and a 2-stent strategy (HR 2.38, CI 1.37 to 4.14, p = 0.002) were independent predictors of ST, whereas intracoronary imaging (HR 0.42, CI 0.23 to 0.78, p = 0.006) and final kissing balloon (FKB) (HR 0.48, CI 0.29 to 0.82, p = 0.007) were protective against ST. Among patients on DAPT, smoking status and a 2-stent strategy significantly increased the risk of ST, while intracoronary imaging and FKB reduced the risk. In conclusion, age, smoking status, chronic kidney disease and a 2-stent strategy were significant predictors of ST, whereas intracoronary imaging use and FKB had a protective effect. Only smoking status and a 2-stent strategy significantly predicted ST in DAPT subgroup, while intracoronary imaging and FKB had a protective role.

Section snippets

Methods

The COBIS II registry (NCT01642992) is a Korean multicenter retrospective registry, enrolling consecutive patients with coronary bifurcation lesions who underwent PCI with a DES from January 2003 to December 2009. The retrospective RAIN (veRy Thin Stents for Patients With Left mAIn or bifurcatioN in Real Life, NCT03544294) registry enrolled consecutive patients treated with very-thin DES (<100 μm) on coronary bifurcations and/or ULM in 15 European Centers from June 2015 to December 2017.

Results

A total of 5537 patients were included in the BIFURCAT registry. For the purpose of the present analysis, 207 patients were excluded due to lack of follow-up data on ST; thus, 5330 patients treated with coronary stenting on coronary bifurcations constituted the study population. Overall, 64 (1.2%) patients developed ST at 2.1 years of follow-up, with most of the events occurring during the first year (Figure 1). Baseline and clinical characteristics of the cohort are reported in Table 1.

Discussion

The main findings of the present study can be summarized as follows:

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    ST is a relatively rare event (1.2%) in this large real-world cohort of patients treated with PCI on coronary bifurcations.

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    Age, smoking status, CKD and a 2-stent strategy were independent predictors of ST, whereas intracoronary imaging and FKB were independent protective factors.

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    Among DAPT-treated patients, only smoking habit and a 2-stent strategy persisted as independent predictors of ST, while both intracoronary imaging and

Disclosures

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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    Funding: COBIS registry was founded by the Korean Society of Interventional Cardiology, Seoul, Republic of Korea, The Korea Health Technology R&D Project through the Korea Health Industry Development Institute, and the Ministry of Health & Welfare, Republic of Korea (grant number: HI10C2020).

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