Abstract 15286: High Frequency of Definite Stent Thrombosis Among Patients with ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention. A Five Years Follow-Up in the SORT OUT II - Study
Objective: Stent thrombosis (ST) is a dreaded complication after percutaneous coronary intervention (PCI). Long term follow-up data regarding the risk of ST accompanied by ST-segment elevation myocardial infarction (STEMI) after PCI with drug-eluting stents are sparse. The aim of this study was to determine the 5-year incidence of ST in patients presenting with STEMI in the SORT OUT II study.
Methods: In SORT OUT II 2,098 patients underwent PCI in 2004-06 and were randomized to Cypher® or Taxus® stent(s). Patients who subsequently suffered one (or more) STEMI(s) and survived to hospitalization, were categorized as definite ST, possible ST or no ST, respectively, using the Academic Research Council classification. Information on medication was obtained from patient records.
Results: We identified 85 patients (4.1%) with a total of 96 STEMIs. Definite ST was confirmed in 60 (62.5%) of the cases by either coronary angiography or autopsy. The remaining 36 cases had possible ST or no ST. In this STEMI-subgroup 20 (23.5%) were initially included due to primary PCI, compared to 17.3% in the entire study population, and we found no difference in the risk of definite ST according to initial PCI urgency (acute, subacute or elective). General characteristics stratified by presence of definite, possible or no ST, are summarized in the table. Important findings include that only 15% of definite ST occurred within 30 days of PCI, and 66% occurred >1 year after PCI. Three quarters of the population were males, but notably the proportion of definite ST was higher among females (81.8% vs. 56.8%, p=0.09). The prevalence of ongoing dual antiplatelet therapy was higher in the definite ST group (28.3% vs. 8.3%, p=0.03).
Conclusion: In a large unselected PCI population treated with first generation drug-eluting stents, the number of subsequent STEMI is low within 5 years of follow-up. More than 60 % of these STEMIs were caused by definite STT. Continued focus on reduction of ST after PCI is warranted.
- © 2012 by American Heart Association, Inc.