JACC: Improved management of STEMI patients needed to avoid stent thrombosis

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Stent thrombosis is associated with a subgroup of patients with STEMI  who have both poor angiographic and early clinical outcomes, suggesting that the management of these patients should be improved, according to a retrospective study in the June 24 issue of the Journal of the American College of Cardiology.

The researchers said that the aim of the study was to compare clinical and angiographic outcomes between patients presenting with STEMI due to stent thrombosis (ST) and de novo coronary thrombosis because there “are limited data for procedural and mid-term outcomes of patients with ST presenting with STEMI.”

Tania Chechi, MD, from the division of the invasive cardiology at the Azienda Ospedaliero-Universitaria Careggi in Florence, Italy, and colleagues said that “ST represents a new, although rare, cause of STEMI that seems to be associated with worse clinical outcomes than STEMI due to coronary thrombosis.”

From January 2004 to March 2007, the investigators observed 115 definite ST patients: 92 (80 percent) of them presented as STEMI and were compared with a consecutive group of 98 patients with de novo STEMI. All patients underwent primary PCI. Primary end points were successful angiographic reperfusion and distal embolization. Major adverse cardiovascular and cerebrovascular events (MACCE), evaluated at six-month follow-up, were defined as death, nonfatal myocardial reinfarction, target vessel revascularization and cerebrovascular accident, according to the authors.

Chechi and colleagues found that successful reperfusion rate was lower in patients with ST, whereas distal embolization rate was higher in comparison with patients with de novo STEMI. ST proved to be an independent predictor of unsuccessful reperfusion at propensity-adjusted binary logistic regression (odds ratio 6.8), according to the authors.

The investigators found that in-hospital MACCE rate was higher in patients with ST, whereas no differences were observed at six-month follow-up among hospital survivors between the two groups.

Based on their findings, Chechi and colleagues said that the “procedural and clinical outcomes after ST could be improved by identification and correction of procedural issues leading to ST in order to avoid its recurrence.” As a result, they recommended that “intravascular ultrasound analysis, performed either during or—even better—after the acute phase of ST, should be considered to assess the optimal stent deployment and the presence of residual dissection.”