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

TY - JOUR

T1 - Clinical impact of intraprocedural stent thrombosis during percutaneous coronary intervention in patients treated with potent p2y12 inhibitors -A validate-swedeheart substudy

AU - Bergman, Sofia

AU - Mohammad, Moman A.

AU - James, Stefan K.

AU - Angerås, Oskar

AU - Wagner, Henrik

AU - Jensen, Jens

AU - Scherstén, Fredrik

AU - Fröbert, Ole

AU - Koul, Sasha

AU - Erlinge, David

N1 - Publisher Copyright: © 2021 The Authors.

PY - 2021/9/21

Y1 - 2021/9/21

N2 - 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.

AB - 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.

KW - Intraprocedural stent thrombosis

KW - Myocardial infarction

KW - Oral P2Y12 inhibitors

KW - Percutaneous coronary intervention

KW - Stent thrombosis

UR - http://www.scopus.com/inward/record.url?scp=85117043291&partnerID=8YFLogxK

U2 - 10.1161/JAHA.121.022984

DO - 10.1161/JAHA.121.022984

M3 - Journal article

C2 - 34514849

AN - SCOPUS:85117043291

SN - 2047-9980

VL - 10

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 18

M1 - e022984

ER -