AI Article Synopsis
- The study examined the effectiveness of emergency percutaneous coronary interventions (PCI) in treating stent thrombosis in 95 out of 6058 patients who received bare-metal stents between 1995 and 2003.
- The majority of patients with stent thrombosis experienced successful PCI, but there were significant risks including myocardial infarction and a subsequent decline in heart function.
- Key findings indicated that achieving optimal blood flow during PCI and having less than 50% artery blockage lowered the risk of cardiac death, while the absence of a specific medication (abciximab) increased the risk of recurrent stent thrombosis.
Article Abstract
Aims: To investigate the efficacy and outcome of emergency percutaneous coronary interventions (PCI) in patients with stent thrombosis.
Methods And Results: Between 1995 and 2003, 6058 patients underwent bare-metal stent implantation, of which 95 (1.6%) patients suffered from stent thrombosis. The timing of stent thrombosis was acute in 10 (11%), subacute in 61 (64%), and late in 24 (25%) patients. Procedural and clinical outcomes of emergency PCI for treatment of stent thrombosis were investigated. Emergency PCI was successful in 86 (91%), complicated by death in 2 (2%), and coronary artery bypass grafting in 2 (2%) patients. Myocardial infarction occurred in 77 (81%) patients with a peak creatine kinase level of 1466+/-1570 U/L. Left ventricular ejection fraction declined from 0.54+/-0.19 prior to 0.48+/-0.16 (P<0.05) at the time of stent thrombosis after emergency PCI. A 6 month major adverse clinical events comprised death (11%), reinfarction (16%), and recurrent stent thrombosis (12%) after emergency PCI. Multivariable logistic regression analysis identified the achievement of TIMI 3 flow (OR=0.1, CI 95% 0.01-0.54, P<0.001) and diameter stenosis <50% (OR=0.06, CI 95% 0.01-0.32, P<0.001) during emergency PCI to be independently associated with a reduced risk of cardiac death. Recurrent stent thrombosis was independently predicted by the omission of abciximab (OR=4.3, CI 95% 1.1-17.5).
Conclusion: Emergency PCI for treatment of stent thrombosis effectively restores vessel patency and flow. Patients presenting with stent thrombosis are at risk for recurrent myocardial infarction and recurrent stent thrombosis.
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| http://dx.doi.org/10.1093/eurheartj/ehi135 | DOI Listing |
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