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CLINICAL RESEARCH: ACUTE CORONARY SYNDROME

ST-Segment Elevation Myocardial Infarction Due to Early and Late Stent Thrombosis

A New Group of High-Risk Patients

Tania Chechi, MD^_*, Sabine Vecchio, MD^_*,_*, Guido Vittori, MD^_*, Gabriele Giuliani, MD^_*, Alessio Lilli, MD^_*, Gaia Spaziani, MD, Lorenzo Consoli, MD^_*, Giorgio Baldereschi, MD, Giuseppe G.L. Biondi-Zoccai, MD, Imad Sheiban, MD and Massimo Margheri, MD^_*

^_* Cardiologia e Cardiologia Invasiva 2, A.O.U. Careggi, Florence, Italy
School of Specialization of Cardiology, University of Florence, Florence, Italy
Unit of Gerontology and Geriatric Medicine, University of Florence, Florence, Italy
Interventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy.

Manuscript received November 12, 2007; revised manuscript received December 21, 2007, accepted January 24, 2008.

^_* Reprint requests and correspondence: Dr. Sabine Vecchio, Cardiologia e Cardiologia Invasiva 2, A.O.U. Careggi, Florence, Viale Morgagni 85, 50134, Florence, Italy. (Email: sabinevecchio{at}gmail.com).

Objectives: The aim of this retrospective study was to compare clinical and angiographic outcomes between patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) and de novo coronary thrombosis.

Background: There are limited data for procedural and mid-term outcomes of patients with ST presenting with STEMI.

Methods: From January 2004 to March 2007, 115 definite ST patients were observed: 92 (80%) of them presented as STEMI and were compared with a consecutive group of 98 patients with de novo STEMI. All patients underwent primary percutaneous coronary intervention. Primary end points were successful angiographic reperfusion and distal embolization. Major adverse cardiovascular and cerebrovascular events (MACCE), evaluated at 6-month follow-up, were defined as death, nonfatal myocardial reinfarction, target vessel revascularization, and cerebrovascular accident.

Results: Successful reperfusion rate was lower in patients with ST (p < 0.0001), whereas distal embolization rate was higher (p = 0.01) in comparison with patients with de novo STEMI. Stent thrombosis proved to be an independent predictor of unsuccessful reperfusion at propensity-adjusted binary logistic regression (odds ratio 6.8, p = 0.004). In-hospital MACCE rate was higher in patients with ST (p = 0.003), whereas no differences were observed at 6-month follow-up among hospital survivors between the 2 groups (p = 0.7).

Conclusions: Stent thrombosis identifies a subgroup of patients with STEMI with poor angiographic and early clinical outcomes, suggesting that the management of these patients should be improved.

Abbreviations and Acronyms   ACS = acute coronary syndrome   BMS = bare-metal stent(s)   CI = confidence interval   DES = drug-eluting stent(s)   HR = hazard ratio   MACCE = major adverse cardiovascular and cerebrovascular events   MI = myocardial infarction   PCI = percutaneous coronary intervention   ST = stent thrombosis   STEMI = ST-segment elevation myocardial infarction   TG = thrombus grade   TIMI = Thrombolysis In Myocardial Infarction   TVR = target vessel revascularization

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