Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom.
Institute of Health Informatics, University College London, London, United Kingdom.
EuroIntervention. 2022 Oct 21;18(9):729-739. doi: 10.4244/EIJ-D-22-00049.
There are limited data on the outcomes of percutaneous coronary intervention (PCI) following stent thrombosis (ST) and differences exist based on timing.
Our aim was to study the rates of PCI procedures for an ST indication among all patients admitted for PCI at a national level and to compare their characteristics and procedural outcomes based on ST timing.
All PCI procedures in England and Wales (2014-2020) were retrospectively analysed and stratified by the presence of ST into four groups: non-ST, early ST (0-30 days), late ST (>30-360 days), very late ST (>360 days). Multivariable logistic regression models were performed to assess the odds ratios (OR) of in-hospital MACCE (major adverse cardiovascular and cerebrovascular events, a composite of mortality, acute stroke and reinfarction) and mortality.
Overall, 7,923 (1.4%) procedures were for ST indication, most commonly for early ST (n=4,171; 52.6%), followed by very late ST (n=2,801; 35.4%) and late ST (n=951; 12.0%). The rate of PCI for ST declined between 2014 and 2020 (1.7 to 1.4%; p<0.001). Early ST was the only subgroup associated with increased odds of MACCE (OR 1.22, 95% CI: 1.05-1.41), all-cause mortality (OR 1.21, 95% CI: 1.07-1.36) and reinfarction (OR 2.48, 95% CI: 1.48-4.14), compared with non-ST indication. The odds of mortality were significantly reduced in ST patients with the use of intravascular imaging (OR 0.66, 95% CI: 0.48-0.92) and newer P2Y inhibitors (ticagrelor: OR 0.69, 95% CI: 0.49-0.95; prasugrel: OR 0.54, 95% CI: 0.30-0.96).
PCI for ST has declined in frequency over a 7-year period, with most procedures performed for early ST. Among the different times of ST onset, only early ST is associated with worse clinical outcomes after PCI. Routine use of intravascular imaging and newer P2Y inhibitors could further improve outcomes in this high-risk procedural group.
关于经皮冠状动脉介入治疗（PCI）后支架血栓形成（ST）的结局数据有限，并且根据时间的不同而存在差异。
我们的目的是研究在全国范围内，因 ST 指征而行 PCI 的所有患者中 PCI 手术的比例，并根据 ST 发生时间比较其特征和手术结局。
回顾性分析了英格兰和威尔士（2014-2020 年）所有的 PCI 手术，并根据 ST 的存在分为 4 组：非 ST、早期 ST（0-30 天）、晚期 ST（>30-360 天）、极晚期 ST（>360 天）。采用多变量逻辑回归模型评估院内 MACCE（主要不良心血管和脑血管事件，死亡、急性卒中和再梗死的综合指标）和死亡率的比值比（OR）。
总体而言，7923 例（1.4%）手术是 ST 指征，最常见的是早期 ST（n=4171；52.6%），其次是极晚期 ST（n=2801；35.4%）和晚期 ST（n=951；12.0%）。2014 年至 2020 年间，因 ST 而行 PCI 的比例下降（1.7%降至 1.4%；p<0.001）。与非 ST 指征相比，早期 ST 是唯一与 MACCE（OR 1.22，95%CI：1.05-1.41）、全因死亡率（OR 1.21，95%CI：1.07-1.36）和再梗死（OR 2.48，95%CI：1.48-4.14）风险增加相关的亚组。与 ST 患者相比，血管内成像（OR 0.66，95%CI：0.48-0.92）和新型 P2Y 抑制剂（替格瑞洛：OR 0.69，95%CI：0.49-0.95；普拉格雷：OR 0.54，95%CI：0.30-0.96）的使用显著降低了死亡率的可能性。
在 7 年期间，因 ST 而行 PCI 的频率有所下降，其中大多数手术是针对早期 ST 进行的。在 ST 发生的不同时间中，只有早期 ST 与 PCI 后更差的临床结局相关。常规使用血管内成像和新型 P2Y 抑制剂可以进一步改善这一高危手术人群的结局。
