Clinical characteristics, procedural and clinical outcome of patients treated with PCI for definitive stent thrombosis: a 12 years single centre experience

Abstract

Background: There are limited data on treatment and long-term clinical outcome after definitive (angiographically confirmed) stent thrombosis (ST). Methods: Retrospective analysis of baseline characteristics and procedural and clinical outcomes in patients with angiographically confirmed ST (ARC classification) from a cohort of 8069 consecutive unselected patients treated by PCI in a single centre (June 2000-December 2012). Results: One hundred thirty consecutive patients with definite ST were included in the analysis (1.6%). a) Main baseline characteristics: male sex 82.3%; age 63±13; diabetes 38.5%; previous renal failure 23.1%; previous AMI 69.2%, peripheral arterial disease (PAD) 16.6%. Clinical presentation was ST-segment elevation myocardial infarction in 68% and cardiogenic shock in 13%. Mean time from stent implantation to ST was 636±1168 days. According to ARC classification, 14.6% were acute; 35.4% subacute; 14.6% late and 35.4% very late. Previous implanted stent was DES in 39.2%. b) Main procedural characteristics: IIbIIIa inhibitors were used in 66.2%; IVUS guidance in 44.6%; manual thrombectomy in 70.8%; new stent implantation in 74.6%. c) Main clinical outcomes: in-hospital mortality was 9.2% and one-year mortality was 12.3%. Two patients (1.5%) experienced recurrent ST on follow-up. Type of previously implanted stent (DES or BMS), time of ST (acute, subacute, late or very late), vessel treated and DES implantation for ST treatment were not related to mortality on follow-up. Independent predictors for one-year mortality were age, PAD, cardiogenic shock on admission and multivessel disease. Conclusion: In a cohort of real-life consecutive patients, PCI for ST was relatively infrequent. Patients presenting with ST had high comorbidity levels. Up to one third of patients had very late ST. Nearly half of the PCI were IVUS-guided. One-year mortality and recurrent ST on follow-up was lower than previously reported; this may be explained by the high rate of IVUS-guided PCI.