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Stent thrombosis during and after acute coronary syndromes: patient-related factors and operator-related factors [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-69679 | DOI: 10.14744/AnatolJCardiol.2020.69679  

Stent thrombosis during and after acute coronary syndromes: patient-related factors and operator-related factors

Martin Kamenik, Petr Widimsky
Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady. Prague, Czech Republic

Objective. Stent thrombosis (ST) is known to be more frequent in acute coronary syndromes (ACS) when compared to stable coronary artery disease. This study analyzed the patient- and operator-related risk factors of ST in ACS setting.
Methods. Coronary angiograms of 1738 consecutive patients admitted between 2014-16 for an ACS to a large tertiary center have been analyzed retrospectively for the presence of ST. Paired angiograms (the first PCI during this ACS and the second angiography at the time of ST) of all patients with ST were analyzed by two independent observers with focus on lesion characteristics and procedure techniques. Clinical and laboratory data were collected.
Results. Stent thrombosis was found in 29 patients (1,6% of all ACS patients). A combination of at least one clinical/laboratory and one lesion/operator risk factor was identified in 28 of 29 (96%) patients.
The following risk factors for ST were found: renal insufficiency (OR=4.14, p<0.001, CI 95%: 1.73-9.88), type 2 diabetes (OR=2.21, p=0.034, CI 95%: 1,06-4,61), excessive alcohol drinking ( OR=3.12, p=0.023, CI 95%: 1.17-8.33), stent implantation for STEMI (OR=2.28, p=0.029, CI 95%: 1.08-4.81), left main or left anterior descending artery as culprit lesion (OR=2.80, p=0.010, CI 95%: 1.27-5.95), absence of antiplatelet therapy prior to ST (OR=3.58, p=0.002, CI 95%: 1.60-7.96). As lesion/operator possible risk factors were identified bifurcation lesion (n=7; 24%), heavy coronary calcifications (n=13; 44%), in-stent restenosis with secondary plate rupture (n=6, 20%), inaproppriate stent size selection (n=6, 20%), errors in periprocedural drug administration (n=4, 14%).
Conclusion. Stent thrombosis after PCI for ACS occurred in 1/62 patients. Almost in all patients a combination of a clinical/laboratory and lesion/operator risk factor was present. This finding may support the search for a more individualized strategy for antithrombotic treatment after PCI for ACS.

Keywords: stent thrombosis, risk factors, acute coronary syndrome, antithrombotic treatment

Corresponding Author: Martin Kamenik, Czech Republic

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