Incidence, Predictors and Outcomes of Subacute Stent Thrombosis following Primary Stenting for ST-elevation Myocardial Infarction

Abstract

Knowledge concerning subacute stent thrombosis (SST) following primary stenting for ST-elevation myocardial infarction (STEMI) is not widely available. We studied the incidence, predictors, and clinical outcomes of SST following STEMI. Methods: We analyzed data from 455 consecutive patients who underwent primary stenting for STEMI. Baseline clinical characteristics, coronary angiographic features, medication and outcome were compared in patients with and without SST. Results: SST occurred in 17 patients, and the incidence was 3.7%. Univariate predictors of SST were being a current smoker (53.0% vs. 82.4%, p = 0.01), Killip class ≥ II (38.4% vs. 58.8%, p = 0.05), no coronary re-flow after stenting (6.2% vs. 17.6%, p = 0.05) and lack of coprescription with a statin (39.5% vs. 5.9%, p<0.01). After multivariate analysis, being a current smoker (odds ratio = 4.76; 95% confidence interval 1.20–18.95) and using statin therapy (odds ratio = 0.09; 95% confidence interval = 0.01–0.75) were independent correlates of SST. Patients with SST were associated with higher 30-day mortality (37.5% vs. 3.1%, p<0.01) and all-cause mortality (23.5% vs. 5.3%, p = 0.01) at long-term follow-up. Conclusion: Although SST is rare in patients with STEMI treated by primary stenting, it imparts a significantly higher mortality at short-term and long-term follow-up. Being a current smoker and the lack of co-prescription with a statin were associated with higher incidence of SST. Our results suggest initiation of statin therapy in patients with STEMI should be considered before discharge.

Keywords

• acute myocardial infarction
• statin
• stent
• thrombosis