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Clinical impact of intraprocedural stent thrombosis during percutaneous coronary intervention in patients treated with potent p2y12 inhibitors -A validate-swedeheart substudy

Bergman, Sofia LU ; Mohammad, Moman A. LU ; James, Stefan K. ; Angerås, Oskar ; Wagner, Henrik LU ; Jensen, Jens ; Scherstén, Fredrik LU ; Fröbert, Ole ; Koul, Sasha LU and Erlinge, David LU orcid (2021) In Journal of the American Heart Association 10(18).
Abstract

BACKGROUND: The clinical importance of intraprocedural stent thrombosis (IPST) during percutaneous coronary intervention in the contemporary era of potent oral P2Y12 inhibitors is not established. The aim of this study was to assess IPST and its association with clinical outcome in patients with myocardial infarction undergoing percutaneous coronary intervention with contemporary antithromboticmedications. METHODS AND RESULTS: The VALIDATE-SWEDEHEART study (Bivalirudin Versus Heparin in ST-Segment and Non–ST- Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies... (More)

BACKGROUND: The clinical importance of intraprocedural stent thrombosis (IPST) during percutaneous coronary intervention in the contemporary era of potent oral P2Y12 inhibitors is not established. The aim of this study was to assess IPST and its association with clinical outcome in patients with myocardial infarction undergoing percutaneous coronary intervention with contemporary antithromboticmedications. METHODS AND RESULTS: The VALIDATE-SWEDEHEART study (Bivalirudin Versus Heparin in ST-Segment and Non–ST- Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial) included 6006 patients with myocardial infarction, treated with potent P2Y12 inhibitors during percutaneous coronary intervention. IPST, defined as a new or worsening thrombus related to a stent deployed during the procedure, was reported by the interventional cardiologist in 55 patients (0.9%) and was significantly associated with ST-segment elevation myocardial infarction presentation, longer stents, bailout glycoprotein IIb/IIIa inhibitors, and final Thrombolysis in Myocardial Infarction flow <3. The primary composite end point included cardiovascular death, myocardial infarction, out-of- laboratory definite stent thrombosis and target vessel revascularization within 30 days. Secondary end points were major bleeding and the individual components of the primary composite end point. Patients with versus without IPST had significantly higher rates of the primary composite end point (20.0% versus 4.4%), including higher rates of cardiovascular death, target vessel revascularization, and definite stent thrombosis, but not myocardial infarction or major bleeding. By multivariable analysis, IPST was independently associated with the primary composite end point (hazard ratio, 3.82; 95% CI, 2.05–7.12; P<0.001). CONCLUSIONS: IPST is a rare but dangerous complication during percutaneous coronary intervention, independently associated with poor prognosis, even in the current era of potent antiplatelet agents. Future treatment studies are needed to reduce the rate of IPST and to improve the poor outcome among these patients. REGISTRATION: URL: Https://www.clini caltr ials.gov; Unique identifier: NCT02311231.

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; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Intraprocedural stent thrombosis, Myocardial infarction, Oral P2Y12 inhibitors, Percutaneous coronary intervention, Stent thrombosis
in
Journal of the American Heart Association
volume
10
issue
18
article number
e022984
publisher
Wiley-Blackwell
external identifiers
  • scopus:85117043291
  • pmid:34514849
ISSN
2047-9980
DOI
10.1161/JAHA.121.022984
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2021 The Authors.
id
d56cb182-f9fc-4c2c-b7d3-e29a3cd9e749
date added to LUP
2021-11-12 15:10:14
date last changed
2024-03-23 13:32:14
@article{d56cb182-f9fc-4c2c-b7d3-e29a3cd9e749,
  abstract     = {{<p>BACKGROUND: The clinical importance of intraprocedural stent thrombosis (IPST) during percutaneous coronary intervention in the contemporary era of potent oral P2Y12 inhibitors is not established. The aim of this study was to assess IPST and its association with clinical outcome in patients with myocardial infarction undergoing percutaneous coronary intervention with contemporary antithromboticmedications. METHODS AND RESULTS: The VALIDATE-SWEDEHEART study (Bivalirudin Versus Heparin in ST-Segment and Non–ST- Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial) included 6006 patients with myocardial infarction, treated with potent P2Y12 inhibitors during percutaneous coronary intervention. IPST, defined as a new or worsening thrombus related to a stent deployed during the procedure, was reported by the interventional cardiologist in 55 patients (0.9%) and was significantly associated with ST-segment elevation myocardial infarction presentation, longer stents, bailout glycoprotein IIb/IIIa inhibitors, and final Thrombolysis in Myocardial Infarction flow &lt;3. The primary composite end point included cardiovascular death, myocardial infarction, out-of- laboratory definite stent thrombosis and target vessel revascularization within 30 days. Secondary end points were major bleeding and the individual components of the primary composite end point. Patients with versus without IPST had significantly higher rates of the primary composite end point (20.0% versus 4.4%), including higher rates of cardiovascular death, target vessel revascularization, and definite stent thrombosis, but not myocardial infarction or major bleeding. By multivariable analysis, IPST was independently associated with the primary composite end point (hazard ratio, 3.82; 95% CI, 2.05–7.12; P&lt;0.001). CONCLUSIONS: IPST is a rare but dangerous complication during percutaneous coronary intervention, independently associated with poor prognosis, even in the current era of potent antiplatelet agents. Future treatment studies are needed to reduce the rate of IPST and to improve the poor outcome among these patients. REGISTRATION: URL: Https://www.clini caltr ials.gov; Unique identifier: NCT02311231.</p>}},
  author       = {{Bergman, Sofia and Mohammad, Moman A. and James, Stefan K. and Angerås, Oskar and Wagner, Henrik and Jensen, Jens and Scherstén, Fredrik and Fröbert, Ole and Koul, Sasha and Erlinge, David}},
  issn         = {{2047-9980}},
  keywords     = {{Intraprocedural stent thrombosis; Myocardial infarction; Oral P2Y12 inhibitors; Percutaneous coronary intervention; Stent thrombosis}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{18}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Clinical impact of intraprocedural stent thrombosis during percutaneous coronary intervention in patients treated with potent p2y12 inhibitors -A validate-swedeheart substudy}},
  url          = {{http://dx.doi.org/10.1161/JAHA.121.022984}},
  doi          = {{10.1161/JAHA.121.022984}},
  volume       = {{10}},
  year         = {{2021}},
}