Incidence, Predictors and Outcomes of Subacute Stent Thrombosis following Primary Stenting for ST-elevation Myocardial Infarction

Background/Purpose

Knowledge concerning subacute stent thrombosis (SST) following primary stenting for ST-elevation myocardial infarction (STEMI) is not widely available. We studied the incidence, predictors, and clinical outcomes of SST following STEMI.

Methods

We analyzed data from 455 consecutive patients who underwent primary stenting for STEMI. Baseline clinical characteristics, coronary angiographic features, medication and outcome were compared in patients with and without SST.

Results

SST occurred in 17 patients, and the incidence was 3.7%. Univariate predictors of SST were being a current smoker (53.0% vs. 82.4%, p = 0.01), Killip class ≥ II (38.4% vs. 58.8%, p = 0.05), no coronary re-flow after stenting (6.2% vs. 17.6%, p = 0.05) and lack of coprescription with a statin (39.5% vs. 5.9%, p<0.01). After multivariate analysis, being a current smoker (odds ratio = 4.76; 95% confidence interval 1.20–18.95) and using statin therapy (odds ratio = 0.09; 95% confidence interval = 0.01–0.75) were independent correlates of SST. Patients with SST were associated with higher 30-day mortality (37.5% vs. 3.1%, p<0.01) and all-cause mortality (23.5% vs. 5.3%, p = 0.01) at long-term follow-up.

Conclusion

Although SST is rare in patients with STEMI treated by primary stenting, it imparts a significantly higher mortality at short-term and long-term follow-up. Being a current smoker and the lack of co-prescription with a statin were associated with higher incidence of SST. Our results suggest initiation of statin therapy in patients with STEMI should be considered before discharge.

Key Words:  acute myocardial infarction , statin , stent , thrombosis

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