Main Article Content
Background: Definite stent thrombosis presents a significant challenge in the field of interventional cardiology, necessitating an in-depth understanding of its incidence, risk factors, and clinical outcomes.
Objective: To determine the frequency, identify the risk factors, and evaluate the clinical outcomes associated with definite stent thrombosis in patients who underwent coronary artery stent implantation.
Methods: This retrospective observational study was conducted at the Peshawar Institute of Cardiology from March 2022 to March 2023. It involved 37 patients with a history of definite stent thrombosis, confirmed by angiographic evidence and symptoms of myocardial ischemia. Data were collected systematically from patient records, angiography results, and electronic databases, focusing on demographics, medical history, procedural details, and outcomes. Statistical analysis included descriptive statistics, chi-square tests for categorical variables, and t-tests or Mann-Whitney U tests for continuous variables.
Results: The study identified 37 cases of definite stent thrombosis. The average age of the patients was 62.5 years, with 67% being male. Comorbidities included hypertension (62%), diabetes mellitus (40%), and previous myocardial infarction (28%). Procedural complications occurred in 18% of cases. The frequency of stent thrombosis was similar for drug-eluting (72%) and bare-metal stents (28%). Recurrent myocardial infarction was reported in 34% of patients, and the mortality rate was 12%.
Conclusion: The study highlights the significant association of older age and procedural complications with the occurrence of definite stent thrombosis. No significant differences were observed in thrombosis rates between drug-eluting and bare-metal stents, though drug-eluting stents showed a trend towards reducing recurrent myocardial infarction. These findings underscore the need for personalized preventive strategies and highlight the importance of careful procedural execution in interventional cardiology.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Khoso AA, Soomro GH, Mal SB, Malik R, Hanif B, Khan R, et al. Frequency, Risk Factors, and Outcome of Definite Stent Thrombosis: A Single-Center Experience. Cureus. 2022;14(7).
Tariq S, Kumar R, Fatima M, Saghir T, Masood S, Karim M. Acute and sub-acute stent thrombosis: frequency, predictors and features in patients undergoing primary percutaneous intervention at a tertiary care cardiac centre. IJC Heart & Vasculature. 2020;26:100427.
Batchelor R, Dinh D, Brennan A, Lefkovits J, Reid C, Duffy SJ, et al. Incidence, predictors and clinical outcomes of stent thrombosis following percutaneous coronary intervention in contemporary practice. Heart, Lung and Circulation. 2020;29(10):1433-9.
Rozemeijer R, Wing Wong C, Leenders G, Timmers L, Koudstaal S, Rittersma S, et al. Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients. Netherlands Heart Journal. 2019;27:321-9.
Ten Haaf M, Appelman Y, Wijns W, Steg G, Mauri L, Rademaker-Havinga T, et al. Frequency of stent thrombosis risk at 5 years in women versus men with zotarolimus-eluting compared with sirolimus-eluting stent. The American Journal of Cardiology. 2016;118(8):1178-86.
Shah N, Chaudhary R, Mehta K, Agarwal V, Garg J, Freudenberger R, et al. Therapeutic hypothermia and stent thrombosis: a nationwide analysis. JACC: Cardiovascular Interventions. 2016;9(17):1801-11.
Maehara A, Mintz GS, Witzenbichler B, Weisz G, Neumann F-J, Rinaldi MJ, et al. Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: two-year follow-up of the ADAPT-DES study. Circulation: Cardiovascular Interventions. 2018;11(11):e006243.
Ünal S, Açar B, Yayla Ç, Balci MM, Ertem A, Kara M, et al. Importance and usage of the CHA2DS2-VASc score in predicting acute stent thrombosis. Coronary Artery Disease. 2016;27(6):478-82.
Ueki Y, Otsuka T, Bär S, Koskinas KC, Heg D, Häner J, et al. Frequency and outcomes of periprocedural MI in patients with chronic coronary syndromes undergoing PCI. Journal of the American College of Cardiology. 2022;79(6):513-26.
Tanık VO, Aruğaslan E, Cinar T, Keskin M, Kaya A, Tekkeşin AI. Association of the CHA2DS2VASc score with acute stent thrombosis in patients with an ST elevation myocardial infarction who underwent a primary percutaneous coronary intervention. Medical Principles and Practice. 2019;28(2):115-23.
Ullrich H, Münzel T, Gori T. Coronary Stent Thrombosis- Predictors and Prevention. Deutsches Arzteblatt international. 2020;117(18):320-6.
Kerkmeijer LS, Claessen BE, Baber U, Sartori S, Chandrasekhar J, Stefanini GG, et al. Incidence, determinants and clinical impact of definite stent thrombosis on mortality in women: From the WIN-DES collaborative patient-level pooled analysis. International journal of cardiology. 2018;263:24-8.
Saleh A, Hammoudeh A, Tabbalat R, Al-Haddad I, Al-Mousa E, Jarrah M, et al. Incidence and prognosis of stent thrombosis following percutaneous coronary intervention in Middle Eastern patients: The First Jordanian Percutaneous Coronary Intervention Registry (JoPCR1). Annals of Saudi medicine. 2016;36(1):17-22.
Gori T, Polimeni A, Indolfi C, Räber L, Adriaenssens T, Münzel T. Predictors of stent thrombosis and their implications for clinical practice. Nature reviews Cardiology. 2019;16(4):243-56.
Lim S, Koh Y-S, Kim P-J, Kim H-Y, Park CS, Lee JM, et al. Incidence, implications, and predictors of stent thrombosis in acute myocardial infarction. The American Journal of Cardiology. 2016;117(10):1562-8.
Singh K, Rashid M, So DY, Glover CA, Froeschl M, Hibbert B, et al. Incidence, predictors, and clinical outcomes of early stent thrombosis in acute myocardial infarction patients treated with primary percutaneous coronary angioplasty (insights from the U niversity of O ttawa H eart I nstitute STEMI registry). Catheterization and Cardiovascular Interventions. 2018;91(5):842-8.
Mohamad T, Jyotsna F, Farooq U, Fatima A, Kar I, Khuwaja S, et al. Individualizing medicinal therapy post heart stent implantation: tailoring for patient factors. Cureus. 2023;15(8).
Mohamed MO, Sirker A, Chieffo A, Avanzas P, Nolan J, Rashid M, et al. Temporal patterns, characteristics, and predictors of clinical outcomes in patients undergoing percutaneous coronary intervention for stent thrombosis. EuroIntervention. 2022;18(9):729.
Nascimento Silva JS, de Barros IML, Cantarelli FL, Alves RC, Falcão FJdA, Silva JMdS, et al. Predictors of coronary stent thrombosis: a case–control study. Journal of Thrombosis and Thrombolysis. 2018;46:420-6.
Coughlan JJ, Maeng M, Räber L, Brugaletta S, Aytekin A, Jensen LO, et al. Ten-year patterns of stent thrombosis after percutaneous coronary intervention with new-versus early-generation drug-eluting stents: Insights from the DECADE cooperation. Revista Española de Cardiología (English Edition). 2022;75(11):894-902.
Kang J, Park KW, Lee HS, Zheng C, Rhee T-M, Ki Y-J, et al. Relative impact of clinical risk versus procedural risk on clinical outcomes after percutaneous coronary intervention. Circulation: Cardiovascular Interventions. 2021;14(2):e009642.
Abdalwahab A, Farag M, Brilakis ES, Galassi AR, Egred M. Management of coronary artery perforation. Cardiovascular Revascularization Medicine. 2021;26:55-60.
Soomro GH, Hussain FI, Ali M, Noor U, Memon ZAS, Yaqoob N. Complications and associated risk factors of percutaneous coronary intervention: A comparative study between primary and elective patients. Journal of the Dow University of Health Sciences (JDUHS). 2022;16(1):9-16.
Piccolo R, Bonaa KH, Efthimiou O, Varenne O, Baldo A, Urban P, et al. Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials. The Lancet. 2019;393(10190):2503-10.
Changal KH, Mir T, Khan S, Nazir S, Elzanatey A, Meenakshisundaram C, et al. Drug-eluting stents versus bare-metal stents in large coronary artery revascularization: systematic review and meta-analysis. Cardiovascular Revascularization Medicine. 2021;23:42-9.
Mikolajewicz N, Komarova SV. Meta-analytic methodology for basic research: a practical guide. Frontiers in physiology. 2019;10:203.