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Comparison of Outcomes After Percutaneous Coronary Intervention Among Different Coronary Subsets (Stable and Unstable Angina Pectoris and ST-Segment and Non-ST-Segment Myocardial Infarction)

      Percutaneous coronary intervention in the setting of acute myocardial infarction is known to predict stent thrombosis (ST). This study aims to compare the ST rates across different coronary subsets. This was an observational cohort study from a large, single-center registry. Included were 12,198 consecutive patients who underwent percutaneous coronary intervention with stenting. Patients were categorized according to their clinical presentation: stable angina pectoris (SAP, n = 3,700), unstable angina pectoris (UAP, n = 2,845), non-ST-segment elevation myocardial infarction (NSTEMI, n = 4,083), and ST-segment elevation myocardial infarction (STEMI, n = 1,570). The study end points were ST rates at 1 year. Patients with STEMI were younger with a lower prevalence of cardiovascular risk factors, except for smoking. More type C lesions were treated in STEMI, whereas drug-eluting stents were used less frequently in patients with STEMI compared with the other groups. Definite ST at 1 year was highest in patients with STEMI (1.4%; vs SAP, 0.4%; UAP, 0.5%; NSTEMI, 0.5%; p <0.001). One-year definite/probable ST rates were SAP, 0.8%; UAP, 1.1%; NSTEMI, 1.4%; and STEMI, 3.2% (p <0.001). On multivariable analysis, STEMI independently predicts definite ST (hazards ratio [HR] 3.07, 95% confidence interval [CI] 1.32 to 7.10), whereas both STEMI (HR 3.36, 95% CI 1.84 to 6.12) and NSTEMI (HR 2.04, 95% CI 1.20 to 3.07) were independent predictors of definite/probable ST. Clopidogrel cessation was the strongest predictor of ST (definite ST, HR 17.00, 95% CI 7.54 to 38.31; definite/probable ST, HR 4.69, 95% CI 2.39 to 9.20). In conclusion, in patients who underwent percutaneous coronary intervention, the acuity of clinical presentation corresponds to an increase in ST incidence. Adherence to clopidogrel is critical to prevent ST in patients who underwent percutaneous coronary intervention, especially in STEMI.
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      References

        • Iakovou I.
        • Schmidt T.
        • Bonizzoni E.
        • Ge L.
        • Sangiorgi G.M.
        • Stankovic G.
        • Airoldi F.
        • Chieffo A.
        • Montorfano M.
        • Carlino M.
        • Michev I.
        • Corvaja N.
        • Briguori C.
        • Gerckens U.
        • Grube E.
        • Colombo A.
        Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.
        JAMA. 2005; 293: 2126-2130
        • Daemen J.
        • Wenaweser P.
        • Tsuchida K.
        • Abrecht L.
        • Vaina S.
        • Morger C.
        • Kukreja N.
        • Jüni P.
        • Sianos G.
        • Hellige G.
        • van Domburg R.T.
        • Hess O.M.
        • Boersma E.
        • Meier B.
        • Windecker S.
        • Serruys P.W.
        Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study.
        Lancet. 2007; 369: 667-678
        • Mauri L.
        • Hsieh W.H.
        • Massaro J.M.
        • Ho K.K.
        • D'Agostino R.
        • Cutlip D.E.
        Stent thrombosis in randomized clinical trials of drug-eluting stents.
        N Engl J Med. 2007; 356: 1020-1029
        • van Werkum J.W.
        • Heestermans A.A.
        • de Korte F.I.
        • Kelder J.C.
        • Suttorp M.J.
        • Rensing B.J.
        • Zwart B.
        • Brueren B.R.
        • Koolen J.J.
        • Dambrink J.H.
        • van't Hof A.W.
        • Verheugt F.W.
        • ten Berg J.M.
        Long-term clinical outcome after a first angiographically confirmed coronary stent thrombosis: an analysis of 431 cases.
        Circulation. 2009; 119: 828-834
        • van Werkum J.W.
        • Heestermans A.A.
        • Zomer A.C.
        • Kelder J.C.
        • Suttorp M.J.
        • Rensing B.J.
        • Koolen J.J.
        • Brueren B.R.
        • Dambrink J.H.
        • Hautvast R.W.
        • Verheugt F.W.
        • ten Berg J.M.
        Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry.
        J Am Coll Cardiol. 2009; 53: 1399-1409
        • de la Torre-Hernández J.M.
        • Alfonso F.
        • Hernández F.
        • Elizaga J.
        • Sanmartin M.
        • Pinar E.
        • Lozano I.
        • Vazquez J.M.
        • Botas J.
        • Perez de Prado A.
        • Hernández J.M.
        • Sanchis J.
        • Nodar J.M.
        • Gomez-Jaume A.
        • Larman M.
        • Diarte J.A.
        • Rodríguez-Collado J.
        • Rumoroso J.R.
        • Lopez-Minguez J.R.
        • Mauri J.
        • ESTROFA Study Group
        Drug-eluting stent thrombosis: results from the multicenter Spanish registry ESTROFA (Estudio ESpañol sobre TROmbosis de stents FArmacoactivos).
        J Am Coll Cardiol. 2008; 51: 986-990
        • Cayla G.
        • Hulot J.S.
        • O'Connor S.A.
        • Pathak A.
        • Scott S.A.
        • Gruel Y.
        • Silvain J.
        • Vignalou J.B.
        • Huerre Y.
        • de la Briolle A.
        • Allanic F.
        • Beygui F.
        • Barthélémy O.
        • Montalescot G.
        • Collet J.P.
        Clinical, angiographic, and genetic factors associated with early coronary stent thrombosis.
        JAMA. 2011; 306: 1765-1774
        • Kukreja N.
        • Onuma Y.
        • Garcia-Garcia H.M.
        • Daemen J.
        • van Domburg R.
        • Serruys P.W.
        • Interventional Cardiologists of the Thoraxcenter (2000 to 2005)
        The risk of stent thrombosis in patients with acute coronary syndromes treated with bare-metal and drug-eluting stents.
        JACC Cardiovasc Interv. 2009; 2: 534-541
        • Iqbal J.
        • Sumaya W.
        • Tatman V.
        • Parviz Y.
        • Morton A.C.
        • Grech E.D.
        • Campbell S.
        • Storey R.F.
        • Gunn J.
        Incidence and predictors of stent thrombosis: a single-centre study of 5,833 consecutive patients undergoing coronary artery stenting.
        EuroIntervention. 2013; 9: 62-69
        • Cutlip D.E.
        • Windecker S.
        • Mehran R.
        • Boam A.
        • Cohen D.J.
        • van Es G.A.
        • Steg P.G.
        • Morel M.A.
        • Mauri L.
        • Vranckx P.
        • McFadden E.
        • Lansky A.
        • Hamon M.
        • Krucoff M.W.
        • Serruys P.W.
        • Academic Research Consortium
        Clinical end points in coronary stent trials: a case for standardized definitions.
        Circulation. 2007; 115: 2344-2351
        • Holmes Jr., D.R.
        • Kereiakes D.J.
        • Garg S.
        • Serruys P.W.
        • Dehmer G.J.
        • Ellis S.G.
        • Williams D.O.
        • Kimura T.
        • Moliterno D.J.
        Stent thrombosis.
        J Am Coll Cardiol. 2010; 56: 1357-1365
        • Dangas G.D.
        • Caixeta A.
        • Mehran R.
        • Parise H.
        • Lansky A.J.
        • Cristea E.
        • Brodie B.R.
        • Witzenbichler B.
        • Guagliumi G.
        • Peruga J.Z.
        • Dudek D.
        • Möeckel M.
        • Stone G.W.
        • Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial Investigators
        Frequency and predictors of stent thrombosis after percutaneous coronary intervention in acute myocardial infarction.
        Circulation. 2011; 123: 1745-1756
        • Beinart R.
        • Abu Sham'a R.
        • Segev A.
        • Hod H.
        • Guetta V.
        • Shechter M.
        • Boyko V.
        • Behar S.
        • Matetzky S.
        The incidence and clinical predictors of early stent thrombosis in patients with acute coronary syndrome.
        Am Heart J. 2010; 159: 118-124
        • Nakazawa G.
        • Finn A.V.
        • Joner M.
        • Ladich E.
        • Kutys R.
        • Mont E.K.
        • Gold H.K.
        • Burke A.P.
        • Kolodgie F.D.
        • Virmani R.
        Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients: an autopsy study.
        Circulation. 2008; 118: 1138-1145
        • Finn A.V.
        • Joner M.
        • Nakazawa G.
        • Kolodgie F.
        • Newell J.
        • John M.C.
        • Gold H.K.
        • Virmani R.
        Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization.
        Circulation. 2007; 115: 2435-2441
        • Cheneau E.
        • Leborgne L.
        • Mintz G.S.
        • Kotani J.
        • Pichard A.D.
        • Satler L.F.
        • Canos D.
        • Castagna M.
        • Weissman N.J.
        • Waksman R.
        Predictors of subacute stent thrombosis: results of a systematic intravascular ultrasound study.
        Circulation. 2003; 108: 43-47
        • Okabe T.
        • Mintz G.S.
        • Buch A.N.
        • Roy P.
        • Hong Y.J.
        • Smith K.A.
        • Torguson R.
        • Gevorkian N.
        • Xue Z.
        • Satler L.F.
        • Kent K.M.
        • Pichard A.D.
        • Weissman N.J.
        • Waksman R.
        Intravascular ultrasound parameters associated with stent thrombosis after drug-eluting stent deployment.
        Am J Cardiol. 2007; 100: 615-620
        • Cook S.
        • Wenaweser P.
        • Togni M.
        • Billinger M.
        • Morger C.
        • Seiler C.
        • Vogel R.
        • Hess O.
        • Meier B.
        • Windecker S.
        Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation.
        Circulation. 2007; 115: 2426-2434
        • Gonzalo N.
        • Barlis P.
        • Serruys P.W.
        • Garcia-Garcia H.M.
        • Onuma Y.
        • Ligthart J.
        • Regar E.
        Incomplete stent apposition and delayed tissue coverage are more frequent in drug-eluting stents implanted during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction than in drug-eluting stents implanted for stable/unstable angina: insights from optical coherence tomography.
        JACC Cardiovasc Interv. 2009; 2: 445-452
        • Katayama T.
        • Nakashima H.
        • Takagi C.
        • Honda Y.
        • Suzuki S.
        • Iwasaki Y.
        • Yamamoto T.
        • Yoshioka M.
        • Yano K.
        Predictors of sub-acute stent thrombosis in acute myocardial infarction patients following primary coronary stenting with bare metal stent.
        Circ J. 2006; 70: 151-155
        • Müller K.
        • Aichele S.
        • Herkommer M.
        • Bigalke B.
        • Stellos K.
        • Htun P.
        • Fateh-Moghadam S.
        • May A.E.
        • Flather M.
        • Gawaz M.
        • Geisler T.
        Impact of inflammatory markers on platelet inhibition and cardiovascular outcome including stent thrombosis in patients with symptomatic coronary artery disease.
        Atherosclerosis. 2010; 213: 256-262
        • Airoldi F.
        • Colombo A.
        • Morici N.
        • Latib A.
        • Cosgrave J.
        • Buellesfeld L.
        • Bonizzoni E.
        • Carlino M.
        • Gerckens U.
        • Godino C.
        • Melzi G.
        • Michev I.
        • Montorfano M.
        • Sangiorgi G.M.
        • Qasim A.
        • Chieffo A.
        • Briguori C.
        • Grube E.
        Incidence and predictors of drug-eluting stent thrombosis during and after discontinuation of thienopyridine treatment.
        Circulation. 2007; 116: 745-754
        • Collins S.D.
        • Torguson R.
        • Gaglia Jr., M.A.
        • Lemesle G.
        • Syed A.I.
        • Ben-Dor I.
        • Li Y.
        • Maluenda G.
        • Kaneshige K.
        • Xue Z.
        • Kent K.M.
        • Pichard A.D.
        • Suddath W.O.
        • Satler L.F.
        • Waksman R.
        Does black ethnicity influence the development of stent thrombosis in the drug-eluting stent era?.
        Circulation. 2010; 122: 1085-1090
        • Osmancik P.
        • Jirmar R.
        • Hulikova K.
        • Peroutka Z.
        • Pompachova A.
        • Motovska Z.
        • Widimsky P.
        A comparison of the VASP index between patients with hemodynamically complicated and uncomplicated acute myocardial infarction.
        Catheter Cardiovasc Interv. 2010; 75: 158-166
        • Orban M.
        • Riegger J.
        • Joner M.
        • Tada T.
        • Okrojek R.
        • Hausleiter J.
        • Kastrati A.
        • Massberg S.
        • Sibbing D.
        Dual thienopyridine low-response to clopidogrel and prasugrel in a patient with STEMI, cardiogenic shock and early stent thrombosis is overcome by ticagrelor.
        Platelets. 2012; 2: 395-398
        • Kirtane A.J.
        • Gupta A.
        • Iyengar S.
        • Moses J.W.
        • Leon M.B.
        • Applegate R.
        • Brodie B.
        • Hannan E.
        • Harjai K.
        • Jensen L.O.
        • Park S.J.
        • Perry R.
        • Racz M.
        • Saia F.
        • Tu J.V.
        • Waksman R.
        • Lansky A.J.
        • Mehran R.
        • Stone G.W.
        Safety and efficacy of drug-eluting and bare metal stents: comprehensive meta-analysis of randomized trials and observational studies.
        Circulation. 2009; 119: 3198-3206
        • Palmerini T.
        • Biondi-Zoccai G.
        • Della Riva D.
        • Stettler C.
        • Sangiorgi D.
        • D'Ascenzo F.
        • Kimura T.
        • Briguori C.
        • Sabatè M.
        • Kim H.S.
        • De Waha A.
        • Kedhi E.
        • Smits P.C.
        • Kaiser C.
        • Sardella G.
        • Marullo A.
        • Kirtane A.J.
        • Leon M.B.
        • Stone G.W.
        Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis.
        Lancet. 2012; 379: 1393-1402
        • Palmerini T.
        • Biondi-Zoccai G.
        • Della Riva D.
        • Mariani A.
        • Genereux P.
        • Branzi A.
        • Stone G.W.
        Stent thrombosis with drug-eluting stents: is the paradigm shifting?.
        J Am Coll Cardiol. 2013; 62: 1915-1921
        • Roy P.
        • Steinberg D.H.
        • Sushinsky S.J.
        • Okabe T.
        • Pinto Slottow T.L.
        • Kaneshige K.
        • Xue Z.
        • Satler L.F.
        • Kent K.M.
        • Suddath W.O.
        • Pichard A.D.
        • Weissman N.J.
        • Lindsay J.
        • Waksman R.
        The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents.
        Eur Heart J. 2008; 29: 1851-1857
        • Dangas G.D.
        • Claessen B.E.
        • Mehran R.
        • Xu K.
        • Fahy M.
        • Parise H.
        • Henriques J.P.
        • Ohman E.M.
        • White H.D.
        • Stone G.W.
        Development and validation of a stent thrombosis risk score in patients with acute coronary syndromes.
        JACC Cardiovasc Interv. 2012; 5: 1097-1105