Journal of the Formosan Medical Association
Volume 109, Issue 6 , Pages 430-437, June 2010

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

  • Su-Kiat Chua

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • ,
  • Huei-Fong Hung

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • Fu-Jen Catholic University School of Medicine, Taipei, Taiwan
    • ,
  • Jun-Jack Cheng

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • Fu-Jen Catholic University School of Medicine, Taipei, Taiwan
    • ,
  • Jen-Hsiang Wang

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • Institute of Radiological Technology, Yuanpei University, Hsinchu, Taiwan
    • ,
  • Huey-Ming Lo

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • Fu-Jen Catholic University School of Medicine, Taipei, Taiwan
    • ,
  • Peiliang Kuan

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • ,
  • Shih-Huang Lee

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • Fu-Jen Catholic University School of Medicine, Taipei, Taiwan
    • ,
  • Sheng-Chang Lin

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • ,
  • Jer-Young Liou

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • ,
  • Che-Ming Chang

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • Fu-Jen Catholic University School of Medicine, Taipei, Taiwan
    • ,
  • Chiung-Zuan Chiu

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • Fu-Jen Catholic University School of Medicine, Taipei, Taiwan
    • ,
  • Kou-Ci Shyu

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Kou-Gi Shyu, Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih-Lin District, Taipei, Taiwan

Received 20 April 2009; received in revised form 24 August 2009; accepted 22 September 2009.

Article Outline

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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References 

  1. Stone GW , Brodie BR , Griffin JJ , et al.   Clinical and angiographic follow-up after primary stenting in acute myocardial infarction: the Primary Angioplasty in Myocardial Infarction (PSTEMI) stent pilot trial . Circulation . 1999;99:1548–1554
  2. Stone GW , Brodie BR , Griffin JJ , et al.   Prospective, multicenter study of the safety and feasibility of primary stenting in acute myocardial infarction: in-hospital and 30-day result of the PSTEMI stent pilot trial . J Am Coll Cardiol . 1998;31:23–30
  3. Grines CL , Cox DA , Stone GW , et al.   Coronary angioplasty with or without stent implantation for acute myocardial infarction . N Engl J Med . 1999;341:1949–1956
  4. Vecchia LL , Bedogni F , Martini M , et al.   Subacute thrombosis after stenting in acute myocardial infarction: four-year experience in a low-volume center . Coronary Artery Dis . 1999;10:521–524
  5. Kernis SJ , Harjai KJ , Stone GW , et al.   The incidence, predictors, and outcomes of early reinfarction after primary angioplasty for acute myocardial infarction . J Am Coll Cardiol . 2003;42:1173–1177
  6. Mauri L , Hsieh WH , Massaro JM , et al.   Stent thrombosis in randomized clinical trials of drug-eluting stents . N Engl J Med . 2007;356:1020–1029
  7. Lee RJ , Lee SH , Shyu KG , et al.   Immediate and long-term outcomes of stent implantation for unprotected left main coronary artery disease . Int J Cardiol . 2001;80:173–177
  8. Lee RJ , Shih KN , Lee SH , et al.   Predictors of long-term outcomes in patients after elective stent implantation for unprotected left main coronary artery disease . Heart Vessels . 2007;22:99–103
  9. Smit JJJ , van't Hof AWJ , Boer MJD , et al.   Incidence and predictors of subacute thrombosis in patients undergoing primary angioplasty for an acute myocardial infarction . Thromb Haemost . 2006;96:190–195
  10. Jones SO , Eckart RE , Shry EA , et al.   Review of subacute stent thrombosis following percutaneous coronary intervention at a low-volume catheterization laboratory . J Interven Cardiol . 2005;18:11–15
  11. Cutlip DE , Baim DS , Ho KKL , et al.   Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trial . Circulation . 2001;103:1967–1971
  12. Cheneau E , Leborgne L , Mintz GS , et al.   Predictors of subacute stent thrombosis: results of a systemic intravascular ultrasound study . Circulation . 2003;108:43–47
  13. Mak KH , Belli G , Ellis SG , et al.   Subacute stent thrombosis: evolving issues and current concepts . J Am Coll Cardiol . 1996;27:494–503
  14. Fagerstrom K . The epidemiology of smoking: health consequences and benefits of cessation . Drugs . 2002;62:1–9
  15. Lilienberg G , Venge P . Platelet adhesion in patients prone to arterial and venous thrombosis: the impacts of gender, smoking and heredity . Scand J Clin Lab Inv . 1998;58:279–286
  16. Rahman MM , Laher I . Structural and functional alteration of blood vessels caused by cigarette smoking: an overview of molecular mechanisms . Curr Vasc Pharm . 2007;5:276–292
  17. Rea TD , Heckbert SR , Kaplan RC , et al.   Smoking status and risk for recurrent coronary events after myocardial infarction . Ann Intern Med . 2002;137:494–500
  18. Sianos G , Papafaklis MI , Daemen J , et al.   Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction . J Am Coll Cardiol . 2007;50:573–583
  19. Ito MK , Talbert RL , Tsimikas S . Statin-associated pleiotropy: possible beneficial effects beyond cholesterol reduction . Pharmacotherapy . 2006;26:S85–S97
  20. Rondina MT , Muhlestein JB . Early initiation of statin therapy in acute coronary syndrome: a review of the evidence . J Interven Cardiol . 2005;28:55–63
  21. Anderson JL , Adams CD , Antman EM , et al.   ACC/AHA 2007 guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: executive summary . J Am Coll Cardiol . 2007;50:652–726
  22. Antman EM , Anbe DT , Armstrong PW , et al.   ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary . J Am Coll Cardiol . 2004;44:671–719
  23. Yin WH , Wang JJ , Jen HL , et al.   Low use of statins in patients with acute myocardial infarction: a single-center experience . Acta Cardiol Sin . 2007;23:79–88
  24. Laarman GJ , Suttorp MJ , Dirksen MT , et al.   Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention . N Engl J Med . 2006;355:1105–1113
  25. Spaulding C , Henry P , Teiger E , et al.   Sirolimus-eluting versus uncoated stents in acute myocardial infarction . N Engl J Med . 2006;355:1093–1104

PII: S0929-6646(10)60074-5

doi:10.1016/S0929-6646(10)60074-5

Journal of the Formosan Medical Association
Volume 109, Issue 6 , Pages 430-437, June 2010

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