scholarly journals Incidence and predictors of coronary stent thrombosis: Evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses

2013 ◽  
Vol 167 (2) ◽  
pp. 575-584 ◽  
Author(s):  
Fabrizio D'Ascenzo ◽  
Mario Bollati ◽  
Fabrizio Clementi ◽  
Davide Castagno ◽  
Bo Lagerqvist ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
Meta Analysis ◽  
Coronary Stent ◽  
International Collaborative

Abstract 37: Short-Term Clinical and Economic Consequences of Coronary Stent Thrombosis

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Christine G Kohn ◽  
Jeffrey Kluger ◽  
Meena Azeem ◽  
Craig I Coleman
Keyword(s):  
Stent Thrombosis ◽  
Meta Analysis ◽  
Treatment Costs ◽  
Coronary Stent ◽  
Economic Consequences ◽  
Bare Metal ◽  
Short Term ◽  
Stent Type ◽  
Statistical Heterogeneity ◽  
Drug Eluting

Objective: To conduct a systematic review and meta-analysis to better quantify the real-world incidence of in-hospital or 30-day death or myocardial infarction (MI) following coronary stent thrombosis (ST), as well as ST-related treatment costs. Methods: We searched Medline, Embase and Scopus from January 2000-July 2012 to identify observational or registry studies that evaluated a cohort of ≥25 patients experiencing angiographically-confirmed thrombosis of a drug-eluting or bare-metal stent, required the use of dual-antiplatelet therapy for guideline recommended durations, and reported on the incidence of in-hospital or 30-day death or MI and/or ST-related treatment costs. Incidences and treatment costs from each study were pooled using random-effects meta-analysis. Statistical heterogeneity was assessed using the I2 statistic (>50% deemed significant). Results: A total of 23 studies were included. Among the 12 studies (N=8,832 STs) reporting in-hospital mortality, the pooled incidence rate was estimated to be 7.9%, 95%CI=5.4%-11.3%, I2=86%. Ten studies (N=1,294 STs) reported 30-day death, with a pooled incidence of 11.6%, 95%CI=8.8%-15.1%, I2=55%. Subgroup analysis suggested patients experiencing early ST (within 30-days of implant) had higher in-hospital and 30-day mortality than those experiencing very-late ST (interaction p<0.04 for both). Stent type (bare-metal vs. drug-eluting) had no significant effect on in-hospital or 30-day mortality (interaction p>0.22 for both). In the 5 studies (N=542 STs) and 3 studies (N=180 STs) reporting in-hospital and 30-day MI, respectively, the pooled incidence rates were 6.1%, 95%CI=2.1%-16.2%, I2=88% and 9.5%, 95%CI=3.8%-22.0%, I2=65%. Only one study reported costs associated with ST, estimating the median/patient cost of hospitalization to treat early ST at $11,134 (in 2000US$). Because of the small number of studies identified, no additional analyses were performed on the MI or the ST-treatment cost endpoints. Conclusions: Regardless of stent type used, the short-term clinical and economic consequences of coronary stent thrombosis (ST) appear significant. While stent type does not seem to affect the incidence of post-ST outcomes, an earlier occurrence of ST may be associated with higher mortality.

Comparison of prasugrel and ticagrelor for patient with acute coronary syndrome: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.C.W Fong ◽  
N Lee ◽  
A.T Yan ◽  
M.Y Ng
Keyword(s):  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Meta Analysis ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Coronary Syndrome ◽  
Primary Composite Endpoint ◽  
Significant Difference ◽  
St Elevation

Abstract Background Prasugrel and ticagrelor are both effective anti-platelet drugs for patients with acute coronary syndrome. However, there has been limited data on the direct comparison of prasugrel and ticagrelor until the recent ISAR-REACT 5 trial. Purpose To compare the efficacy of prasugrel and ticagrelor in patients with acute coronary syndrome with respect to the primary composite endpoint of myocardial infarction (MI), stroke or cardiac cardiovascular death, and secondary endpoints including MI, stroke, cardiovascular death, major bleeding (Bleeding Academic Research Consortium (BARC) type 2 or above), and stent thrombosis within 1 year. Methods Meta-analysis was performed on randomised controlled trials (RCT) up to December 2019 that randomised patients with acute coronary syndrome to either prasugrel or ticagrelor. RCTs were identified from Medline, Embase and ClinicalTrials.gov using Cochrane library CENTRAL by 2 independent reviewers with “prasugrel” and “ticagrelor” as search terms. Effect estimates with confidence intervals were generated using the random effects model by extracting outcome data from the RCTs to compare the primary and secondary clinical outcomes. Cochrane risk-of-bias tool for randomised trials (Ver 2.0) was used for assessment of all eligible RCTs. Results 411 reports were screened, and we identified 11 eligible RCTs with 6098 patients randomised to prasugrel (n=3050) or ticagrelor (n=3048). The included trials had a follow up period ranging from 1 day to 1 year. 330 events on the prasugrel arm and 408 events on the ticagrelor arm were recorded. There were some concerns over the integrity of allocation concealment over 7 trials otherwise risk of other bias was minimal. Patients had a mean age of 61±4 (76% male; 50% with ST elevation MI; 35% with non-ST elevation MI; 15% with unstable angina; 25% with diabetes mellitus; 64% with hypertension; 51% with hyperlipidaemia; 42% smokers). There was no significant difference in risk between the prasugrel group and the ticagrelor group on the primary composite endpoint (Figure 1) (Risk Ratio (RR)=1.17; 95% CI=0.97–1.41; p=0.10, I2=0%). There was no significant difference between the use of prasugrel and ticagrelor with respect to MI (RR=1.24; 95% CI=0.81–1.90; p=0.31); stroke (RR=1.05; 95% CI=0.66–1.67; p=0.84); cardiovascular death (RR=1.01; 95% CI=0.75–1.36; p=0.95); BARC type 2 or above bleeding (RR=1.17; 95% CI =0.90–1.54; p=0.24); stent thrombosis (RR=1.58; 95% CI =0.90–2.76; p=0.11). Conclusion Compared with ticagrelor, prasugrel did not reduce the primary composite endpoint of MI, stroke and cardiovascular death within 1 year. There was also no significant difference in the risk of MI, stroke, cardiovascular death, major bleeding and stent thrombosis respectively. Figure 1. Primary Objective Funding Acknowledgement Type of funding source: None

Abstract 11526: Intraprocedural Thrombotic Events During PCI for ACS Are Associated With Increased Adverse Ischemic Events at 30 Days: A Meta-Analysis of Randomized Trials

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ramez Nairooz ◽  
Partha Sardar ◽  
Saurav Chatterjee ◽  
Zubair Ahmed ◽  
Dmitriy N Feldman
Keyword(s):  
Clinical Outcomes ◽  
Stent Thrombosis ◽  
Literature Search ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Major Adverse Cardiovascular Events ◽  
Repeat Revascularization ◽  
Coronary Syndrome ◽  
Reported Data ◽  
Ischemic Events

Background: Data regarding intraprocedural thrombotic events (IPTE) including slow reflow or no reflow, distal embolization, intraprocedural stent thrombosis and abrupt vessel closure during PCI for acute coronary syndrome (ACS) are scarce. Their association with subsequent adverse ischemic events needs further investigation. Aim: To evaluate effect of IPTE on in-hospital and at 30-days clinical outcomes after PCI for ACS. Hypothesis: IPTE during PCI are associated with adverse ischemic events while in-hospital and at 30 days. Methods: We performed a literature search of all published full-length articles of randomized trials that reported data on patients with IPTE compared with no IPTE during PCI for patients with ACS. We calculated odd ratios via random effects model for in-hospital ischemic outcomes and 30 day outcomes. Results: Our literature search yielded 3 randomized trials reporting clinical outcomes with IPTE and no IPTE for ACS patients undergoing PCI: ACUITY, HORIZONS-AMI and EARLY-ACS trials. We report clinical outcomes (in-hospital and at 30 days) in 8,043 patients in total, of those 673 had IPTE. At 30 days, patients with IPTE had more major adverse cardiovascular events (MACE) (Odds ratio (OR) 3.97, 95% Confidence interval (CI) [1.81-8.69]; p=0.0006), mortality (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003), myocardial infarction (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003), repeat revascularization (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003), total stent thrombosis (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003) and non-CABG related major bleeding (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003) than those with no IPTE. Similarly, in-hospital clinical outcomes were all significantly higher in patients with IPTE than those without. Conclusion: IPTE during PCI is associated with more adverse ischemic events, including mortality, both in-hospital and at 30 days.

Coronary Stent Thrombosis

2018 ◽  
pp. 995-1006
Author(s):  
Geraud Souteyrand ◽  
Nicolas Combaret ◽  
Nicolas Amabile ◽  
Pascal Motreff
Keyword(s):  
Stent Thrombosis ◽  
Coronary Stent

scholarly journals Everolimus-Eluting versus Paclitaxel-Eluting Stents in Percutaneous Coronary Intervention: Meta-Analysis of Randomized Trials

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Ashraf Alazzoni ◽  
Ayman Al-Saleh ◽  
Sanjit S. Jolly
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Target Vessel Revascularization ◽  
Percutaneous Coronary

Background. Individual randomized trials have suggested that everolimus-eluting stents may have improved clinical outcomes compared to paclitaxel-eluting stents, but individual trials are underpowered to examine outcomes such as mortality and very late stent thrombosis. Methods. Medline, Cochrane, and conference proceedings were searched for randomized trials comparing everolimus versus paclitaxel-eluting stents for percutaneous coronary intervention. Results. 6792 patients were included from 4 randomized controlled trials. Stent thrombosis was reduced with everolimus stents versus paclitaxel stents (0.7% versus 2.3%; OR: 0.32; CI: 0.20–0.51; P<0.00001). The reductions in stent thrombosis were observed in (i) early stent thrombosis (within 30 days) (0.2% versus 0.9%; OR: 0.24; P=0.0005), (ii) late (day 31–365) (0.2% versus 0.6%; OR: 0.32; P=0.01), and (iii) very late stent thrombosis (>365 days) (0.2% versus 0.8%; OR: 0.34; P=0.009). The rates of cardiovascular mortality were 1.2% in everolimus group and 1.6% in paclitaxel group (OR: 0.85; P=0.43). Patients receiving everolimus-eluting stents had significantly lower myocardial infarction events and target vessel revascularization as compared to paclitaxel-eluting stents. Interpretation. Everolimus compared to paclitaxel-eluting stents reduced the incidence of early, late, and very late stent thrombosis as well as target vessel revascularization.

scholarly journals Early, Subacute Coronary Stent Thrombosis: A Complication of COVID-19 Infection

2021 ◽  
pp. 1-4
Author(s):  
Sadeq Tabatabai ◽  
Nooshin Bazargani ◽  
Kamaleldin Al-Tahmody ◽  
Jasem Mohammed Alhashmi
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Stent Thrombosis ◽  
Coronary Angioplasty ◽  
Anterior Wall ◽  
Coronary Stent ◽  
Antithrombotic Agents ◽  
Health Care Burden ◽  
Primary Coronary Angioplasty

Soon after it was discovered in Wuhan, China, in December 2019, coronavirus disease 2019 (COVID-19) blow-out very fast and became a pandemic. The usual presentation is respiratory tract infection, but cardiovascular system involvement is sometimes fatal and also a serious personal and health care burden. We report a case of a 57-year-old man who was admitted with anterior wall acute myocardial infarction secondary to early coronary stent thrombosis and associated with COVID-19 infection. He was managed with primary coronary angioplasty and discharged home. Procoagulant and hypercoagulability status associated with severe acute respiratory syndrome coronavirus 2 infection is the most likely culprit. Choosing aggressive antithrombotic agents after coronary angioplasty to prevent stent thrombosis during the COVID-19 pandemic may be the answer but could be challenging.

Sign in / Sign up

Export Citation Format

Share Document