Contemporary management of stent thrombosis: Predictors of mortality and the role of new-generation drug-eluting stents.
Catheter Cardiovasc Interv
; 96(1): E8-E16, 2020 07.
Article
em En
| MEDLINE
| ID: mdl-31498964
ABSTRACT
OBJECTIVES:
We sought to evaluate mortality predictors and the role of new-generation drug-eluting stents (NG-DES) in stent thrombosis (ST) management.BACKGROUND:
No data are available regarding the outcome of patients with ST after interventional management that includes exclusively NG-DES.METHODS:
Patients with definite ST of DES or BMS who underwent urgent/emergent angiography between 2015 and 2018 at our institution were considered for the study. After excluding patients who achieved TIMI-flow<2 after intervention or received an old-generation stent, 131 patients were included. Management classification was stent or non-stent treatment (medical management, thromboaspiration, balloon-angioplasty). Follow-up was performed to document all-cause death (ACD) and target-lesion-revascularization (TLR) that was used for censorship.RESULTS:
Mode of presentation was STEMI in 88% and UA/NSTEMI in 12%. Type of ST was early, late, and very late in 11, 4, and 85%, respectively. Eighty four patients received stent and 47 non-stent treatment. After 926 ± 34 days, 21 ACDs, 7 TLRs and no cases of definite, recurrent ST were observed. Univariate predictors of in-hospital mortality were LVEF and presentation with shock or cardiac arrest. For patients discharged alive, non-stent treatment (HR 4.2, p = .01), TIMI-2 flow (HR 7.4, p = .002) and GFR < 60 mL/min (HR 3.8, p = .01) were independent predictors of ACD. The stent-treatment group had significantly better ACD-free survival after discharge, both unadjusted (p = .022) and adjusted (p = .018).CONCLUSIONS:
After ST management, different predictors were observed for in-hospital mortality and mortality in patients discharged alive. The better outcome with NG-DES treatment is a novel observation, warranting further studies to elucidate if it is associated with stent-related or patient-related factors.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Trombose Coronária
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Fármacos Cardiovasculares
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Angioplastia Coronária com Balão
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Trombectomia
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Stents Farmacológicos
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Intervenção Coronária Percutânea
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Reino Unido