Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady; Prague-Czech Republic.
Anatol J Cardiol. 2020 Oct;24(4):274-279. doi: 10.14744/AnatolJCardiol.2020.69679.
Stent thrombosis (ST) is a common phenomenon in acute coronary syndromes (ACS) when compared to stable coronary artery disease. This study analyzed the patient- and operator-related risk factors of ST in ACS.
Coronary angiograms of 1738 consecutive ACS patients admitted in a large tertiary center between year 2014 and 2016 were analyzed retrospectively for the presence of ST. The paired angiograms [ST in ACS during and after percutaneous coronary intervention (PCI)] of the patients were analyzed by two independent observers, with focus on lesion characteristics and procedure techniques. Clinical and laboratory data were collected.
Stent thrombosis was found in 29 (1.6%) ACS patients, with a combination of at least one clinical/laboratory risk factor and one lesion/operator risk factor identified in 28 (96%) out of the 29 ACS patients with ST. The following risk factors for ST were found: Renal insufficiency (OR=4.14, p<0.001, 95% CI=1.73-9.88), type 2 diabetes (OR=2.21, p=0.034, 95% CI=1.06-4.61), excessive alcohol consumption (OR=3.12, p=0.023, 95% CI=1.17-8.33), stent implantation for ST-elevation myocardial infarction (STEMI) (OR=2.28, p=0.029, 95% CI=1.08-4.81), left main (LM) or left anterior descending artery (LAD) as culprit lesion (OR=2.80, p=0.010, CI 95%=1.27-5.95), and absence of antiplatelet therapy prior to ST (OR=3.58, p=0.002, 95% CI=1.60-7.96). The following lesion/operator possible risk factors were identified: Bifurcation lesion (n=7; 24%), heavy coronary calcifications (n=13; 44%), in-stent restenosis with secondary plate rupture (n=6, 20%), inappropriate stent size selection (n=6, 20%), and errors in periprocedural drug administration (n=4, 14%).
ST occurred in 1/62 ACS patients after PCI. A combination of clinical/laboratory and lesion/operator risk factors were present in almost all ACS patients with ST. This finding may support the search for strictly individualized strategies for the treatment of ACS patients with ST after PCI.
支架血栓形成（ST）在急性冠状动脉综合征（ACS）中比稳定型冠状动脉疾病更为常见。本研究分析了 ACS 中与患者和术者相关的 ST 风险因素。
回顾性分析了 2014 年至 2016 年间在一家大型三级中心收治的 1738 例连续 ACS 患者的冠状动脉造影，以确定 ST 的存在。对患者的配对血管造影（ACS 期间和经皮冠状动脉介入治疗（PCI）后的 ST）由两名独立观察者进行分析，重点关注病变特征和手术技术。收集临床和实验室数据。
29 例（1.6%）ACS 患者发生 ST，其中 28 例（96%）至少有一个临床/实验室危险因素和一个病变/术者危险因素。发现 ST 的以下风险因素：肾功能不全（OR=4.14，p<0.001，95%CI=1.73-9.88）、2 型糖尿病（OR=2.21，p=0.034，95%CI=1.06-4.61）、过度饮酒（OR=3.12，p=0.023，95%CI=1.17-8.33）、ST 段抬高型心肌梗死（STEMI）患者支架植入（OR=2.28，p=0.029，95%CI=1.08-4.81）、左主干（LM）或左前降支（LAD）作为罪犯病变（OR=2.80，p=0.010，CI 95%=1.27-5.95）、以及 ST 前未接受抗血小板治疗（OR=3.58，p=0.002，95%CI=1.60-7.96）。发现以下病变/术者可能的危险因素：分叉病变（n=7；24%）、重度冠状动脉钙化（n=13；44%）、支架内再狭窄伴继发性斑块破裂（n=6，20%）、支架尺寸选择不当（n=6，20%）和围手术期药物应用错误（n=4，14%）。
PCI 后，62 例 ACS 患者中有 1 例发生 ST。几乎所有 ACS 合并 ST 的患者均存在临床/实验室和病变/术者危险因素。这一发现可能支持对 PCI 后合并 ST 的 ACS 患者进行个体化治疗策略的探索。
