Outcome of Primary Percutaneous Coronary Intervention for STEMI due to Stent Thrombosis
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Abstract
Background: Stent thrombosis (ST) is a critical complication following percutaneous coronary intervention (PCI), contributing significantly to morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI). Advances in drug-eluting stent technology and antiplatelet therapy have mitigated, but not eliminated, the risk of ST. The management of STEMI due to ST in resource-limited settings remains a challenging endeavor, necessitating a comprehensive evaluation of treatment outcomes.
Objective: To assess the mortality rates and clinical outcomes following primary PCI in patients with STEMI attributed to stent thrombosis in a resource-constrained setting, and to analyze the association of mortality with patient age and TIMI flow grade post-PCI.
Methods: This quasi-experimental study was conducted at Lady Reading Hospital, Peshawar, from July to December 2023. A total of 150 patients presenting with STEMI due to ST and undergoing PCI were included. Diagnostic measures included electrocardiography, troponin levels, echocardiography, and angiography to assess left ventricular function and stent thrombosis. The procedures were performed by experienced interventional cardiologists, followed by standard post-procedure management. Data analysis was performed using SPSS version 25, focusing on mortality rates, the association of mortality with patient age, and TIMI flow grades.
Results: Among the 150 patients studied, mortality was observed in 36 cases (24%). The mean age of patients who died was 48.33 years (SD = 14.267), compared to 42.47 years (SD = 12.618) for survivors, with a significant association between age and mortality (P = 0.02). Analysis of TIMI flow grade post-PCI revealed a strong correlation with mortality; patients with TIMI flow grades I and II exhibited higher mortality rates, with a highly significant P value of 0.0001.
Conclusion: The study highlights a significant mortality rate among patients with STEMI due to stent thrombosis undergoing primary PCI in a resource-limited setting. Advanced age and lower TIMI flow grades post-PCI were significantly associated with increased mortality. These findings underscore the necessity for vigilant post-PCI monitoring and tailored management strategies to improve clinical outcomes in this high-risk population.
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References
Aldujeli A, Haq A, Tsai T-Y, Grabauskyte I, Tatarunas V, Briedis K, et al. The impact of primary percutaneous coronary intervention strategies during ST-elevation myocardial infarction on the prevalence of coronary microvascular dysfunction. Scientific reports. 2023;13(1):20094.
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.
Bergman S, Mohammad MA, James SK, Angerås O, Wagner H, Jensen J, et al. Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors‐a VALIDATE‐SWEDEHEART Substudy. Journal of the American Heart Association. 2021;10(18):e022984.
Condello F, Spaccarotella C, Sorrentino S, Indolfi C, Stefanini GG, Polimeni A. Stent thrombosis and restenosis with contemporary drug-eluting stents: predictors and current evidence. Journal of Clinical Medicine. 2023;12(3):1238.
Erdogan E, Bajaj R, Lansky A, Mathur A, Baumbach A, Bourantas CV. Intravascular Imaging for Guiding In‐Stent Restenosis and Stent Thrombosis Therapy. Journal of the American Heart Association. 2022;11(22):e026492.
Köktürk U, Somuncu MU, Uygur B, Akgül Ö, Püşüroğlu H. Prognostic significance of thrombus burden on short-and long-term clinical outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coronary Artery Disease. 2022;33(7):559-65.
Kumar D, Patra S, Pande A, Chakraborty R, Mukherjee SS, Roy RR, et al. Long-term clinical outcomes of thrombus aspiration in STEMI patients undergoing primary percutaneous coronary intervention. American Journal of Cardiovascular Disease. 2020;10(2):117.
Kumar M, Shar GS, Kumar R, Shaikh AH, Ishaque H, Khan N, et al. The outcome of primary percutaneous coronary intervention in patients with stent thrombosis. Indian Heart Journal. 2022;74(6):464-8.
Kumar R, Ammar A, Saghir T, Sial JA, Shah JA, Kumar A, et al. Incidence, predictors, and outcomes of acute and sub-acute stent thrombosis after emergency percutaneous coronary revascularization with drug-eluting stents: a prospective observational study. Global Heart. 2022;17(1).
Kumar R, Tariq S, Fatima M, Saghir T, Batra MK, Karim M, et al. Validity of the Stent Thrombosis Risk Score in Predicting Early Stent Thrombosis after Primary Percutaneous Coronary Intervention. Journal of the Saudi Heart Association. 2020;32(2):256.
Luo D, Hu X, Sun S, Wang C, Yang X, Ye J, et al. The outcomes in STEMI patients with high thrombus burden treated by deferred versus immediate stent implantation in primary percutaneous coronary intervention: a prospective cohort study. Annals of Translational Medicine. 2021;9(7).
Madsen JM, Kelbæk H, Nepper-Christensen L, Jacobsen MR, Ahtarovski KA, Høfsten DE, et al. Clinical outcomes of no stenting in patients with ST-segment elevation myocardial infarction undergoing deferred primary percutaneous coronary intervention. EuroIntervention. 2022;18(6):482.
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.
Noaman S, O'Brien J, Andrianopoulos N, Brennan AL, Dinh D, Reid C, et al. Clinical outcomes following ST‐elevation myocardial infarction secondary to stent thrombosis treated by percutaneous coronary intervention. Catheterization and Cardiovascular Interventions. 2020;96(4):E406-E15.
Rajakariar K, Andrianopoulos N, Gayed D, Liang D, Backhouse B, Ajani AE, et al. Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST‐elevation myocardial infarction. Internal Medicine Journal. 2023;53(8):1376-82.
Saadat N, Saadatagah S, Aghajani Nargesi A, Alidoosti M, Poorhosseini H, Amirzadegan A, et al. Short‐term safety and long‐term benefits of stent postdilation after primary percutaneous coronary intervention: Results of a cohort study. Catheterization and Cardiovascular Interventions. 2020;95(7):1249-56.
Shaikh S, Mal V, Kumar J, Ahmed S, Memon FF, Adrani B. The frequency of early subacute stent thrombosis after primary percutaneous coronary intervention in patients with St-segment. Elevat Myocard Infarct. 2022;16(1):530-4.
SOOMRO ZZ, KOREJO AA, BHATTI KI, SIAL JA, Hassan G. Frequency of acute stent thrombosis after primary percutaneous coronary intervention in patients with ST-Elevation myocardial infarction. PJMHS. 2021;15(9):2550-3.
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.
Thrane PG, Olesen KKW, Thim T, Gyldenkerne C, Mortensen MB, Kristensen SD, et al. Mortality trends after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Journal of the American College of Cardiology. 2023;82(10):999-1010.
Ullah I, Qureshi AR, Ullah S, Khan MA, Salman M, Shah HA. Predictors of Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention. Journal of Gandhara Medical and Dental Science. 2023;10(2):67-70.
Yang Y-X, Liu Y, Li X-W, Lu P-J, Wang J, Li C-P, et al. Clinical outcomes after percutaneous coronary intervention for early versus late and very late stent thrombosis: a systematic review and meta-analysis. Journal of Thrombosis and Thrombolysis. 2021;51:682-92.