Predictors and implications of stent thrombosis in non-ST-segment elevation acute coronary syndromes the ACUITY trial

Tullio Palmerini, George Dangas, Roxana Mehran, Adriano Caixeta, Philippe Genereux, Martin P. Fahy, Ke Xu, Ecaterina Cristea, Alexandra J. Lansky, Gregg W. Stone

Research output: Contribution to journalArticle

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Abstract

Background-The frequency, predictors, and consequences of stent thrombosis (ST) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) have been incompletely studied. We sought to investigate the incidence, predictors, and clinical implications of ST occurring within 1 year after percutaneous coronary intervention in patients with NSTE-ACS. Methods and Results-The Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial was a large-scale, prospective, randomized trial of antithrombotic regimens in patients with NSTE-ACS. The present analysis includes 7162 patients in whom stents were implanted. At 1 year, definite/probable ST occurred in 146 patients (2.2%), including 94 definite and 52 probable events. There were 100 episodes (1.4%) of early ST (within the first 30 days) and 46 episodes (0.8%) of late ST (between 30 days and 1 year). The incidence of ST within 1 year was similar in patients treated with drug-eluting stents or bare metal stents (hazard ratio, 0.86; 95% confidence interval, 0.62-1.20; P=0.38) and was independent of procedural antithrombotic treatment. Patients with ST compared with those without ST had strikingly higher 1-year rates of cardiac mortality (32.4% versus 2.9%, P<0.0001), myocardial infarction (82.6% versus 7.6%, P<0.0001), and target vessel revascularization (79.6% versus 7.4%, P<0.0001). Independent predictors of 1-year definite/probable ST were insulin-treated diabetes mellitus, number of diseased vessels, and ST-segment deviation ≥1 mm. Conclusions-Compared with elective stent implantation, ST occurs with increased frequency in the first year after stent implantation in patients with NSTE-ACS, especially within the first 30 days, and is associated with marked increases in cardiac mortality and adverse events. Insulin-treated diabetes, number of diseased vessels, and dynamic ST-segment changes were independent predictors of 1-year ST in NSTE-ACS.

Original languageEnglish (US)
Pages (from-to)577-584
Number of pages8
JournalCirculation: Cardiovascular Interventions
Volume4
Issue number6
DOIs
StatePublished - Dec 1 2011
Externally publishedYes

Fingerprint

Triage
Acute Coronary Syndrome
Catheterization
Stents
Thrombosis
Insulin
Drug-Eluting Stents
Mortality
Incidence
Percutaneous Coronary Intervention

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Palmerini, Tullio ; Dangas, George ; Mehran, Roxana ; Caixeta, Adriano ; Genereux, Philippe ; Fahy, Martin P. ; Xu, Ke ; Cristea, Ecaterina ; Lansky, Alexandra J. ; Stone, Gregg W. / Predictors and implications of stent thrombosis in non-ST-segment elevation acute coronary syndromes the ACUITY trial. In: Circulation: Cardiovascular Interventions. 2011 ; Vol. 4, No. 6. pp. 577-584.
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title = "Predictors and implications of stent thrombosis in non-ST-segment elevation acute coronary syndromes the ACUITY trial",
abstract = "Background-The frequency, predictors, and consequences of stent thrombosis (ST) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) have been incompletely studied. We sought to investigate the incidence, predictors, and clinical implications of ST occurring within 1 year after percutaneous coronary intervention in patients with NSTE-ACS. Methods and Results-The Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial was a large-scale, prospective, randomized trial of antithrombotic regimens in patients with NSTE-ACS. The present analysis includes 7162 patients in whom stents were implanted. At 1 year, definite/probable ST occurred in 146 patients (2.2{\%}), including 94 definite and 52 probable events. There were 100 episodes (1.4{\%}) of early ST (within the first 30 days) and 46 episodes (0.8{\%}) of late ST (between 30 days and 1 year). The incidence of ST within 1 year was similar in patients treated with drug-eluting stents or bare metal stents (hazard ratio, 0.86; 95{\%} confidence interval, 0.62-1.20; P=0.38) and was independent of procedural antithrombotic treatment. Patients with ST compared with those without ST had strikingly higher 1-year rates of cardiac mortality (32.4{\%} versus 2.9{\%}, P<0.0001), myocardial infarction (82.6{\%} versus 7.6{\%}, P<0.0001), and target vessel revascularization (79.6{\%} versus 7.4{\%}, P<0.0001). Independent predictors of 1-year definite/probable ST were insulin-treated diabetes mellitus, number of diseased vessels, and ST-segment deviation ≥1 mm. Conclusions-Compared with elective stent implantation, ST occurs with increased frequency in the first year after stent implantation in patients with NSTE-ACS, especially within the first 30 days, and is associated with marked increases in cardiac mortality and adverse events. Insulin-treated diabetes, number of diseased vessels, and dynamic ST-segment changes were independent predictors of 1-year ST in NSTE-ACS.",
author = "Tullio Palmerini and George Dangas and Roxana Mehran and Adriano Caixeta and Philippe Genereux and Fahy, {Martin P.} and Ke Xu and Ecaterina Cristea and Lansky, {Alexandra J.} and Stone, {Gregg W.}",
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Predictors and implications of stent thrombosis in non-ST-segment elevation acute coronary syndromes the ACUITY trial. / Palmerini, Tullio; Dangas, George; Mehran, Roxana; Caixeta, Adriano; Genereux, Philippe; Fahy, Martin P.; Xu, Ke; Cristea, Ecaterina; Lansky, Alexandra J.; Stone, Gregg W.

In: Circulation: Cardiovascular Interventions, Vol. 4, No. 6, 01.12.2011, p. 577-584.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors and implications of stent thrombosis in non-ST-segment elevation acute coronary syndromes the ACUITY trial

AU - Palmerini, Tullio

AU - Dangas, George

AU - Mehran, Roxana

AU - Caixeta, Adriano

AU - Genereux, Philippe

AU - Fahy, Martin P.

AU - Xu, Ke

AU - Cristea, Ecaterina

AU - Lansky, Alexandra J.

AU - Stone, Gregg W.

PY - 2011/12/1

Y1 - 2011/12/1

N2 - Background-The frequency, predictors, and consequences of stent thrombosis (ST) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) have been incompletely studied. We sought to investigate the incidence, predictors, and clinical implications of ST occurring within 1 year after percutaneous coronary intervention in patients with NSTE-ACS. Methods and Results-The Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial was a large-scale, prospective, randomized trial of antithrombotic regimens in patients with NSTE-ACS. The present analysis includes 7162 patients in whom stents were implanted. At 1 year, definite/probable ST occurred in 146 patients (2.2%), including 94 definite and 52 probable events. There were 100 episodes (1.4%) of early ST (within the first 30 days) and 46 episodes (0.8%) of late ST (between 30 days and 1 year). The incidence of ST within 1 year was similar in patients treated with drug-eluting stents or bare metal stents (hazard ratio, 0.86; 95% confidence interval, 0.62-1.20; P=0.38) and was independent of procedural antithrombotic treatment. Patients with ST compared with those without ST had strikingly higher 1-year rates of cardiac mortality (32.4% versus 2.9%, P<0.0001), myocardial infarction (82.6% versus 7.6%, P<0.0001), and target vessel revascularization (79.6% versus 7.4%, P<0.0001). Independent predictors of 1-year definite/probable ST were insulin-treated diabetes mellitus, number of diseased vessels, and ST-segment deviation ≥1 mm. Conclusions-Compared with elective stent implantation, ST occurs with increased frequency in the first year after stent implantation in patients with NSTE-ACS, especially within the first 30 days, and is associated with marked increases in cardiac mortality and adverse events. Insulin-treated diabetes, number of diseased vessels, and dynamic ST-segment changes were independent predictors of 1-year ST in NSTE-ACS.

AB - Background-The frequency, predictors, and consequences of stent thrombosis (ST) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) have been incompletely studied. We sought to investigate the incidence, predictors, and clinical implications of ST occurring within 1 year after percutaneous coronary intervention in patients with NSTE-ACS. Methods and Results-The Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial was a large-scale, prospective, randomized trial of antithrombotic regimens in patients with NSTE-ACS. The present analysis includes 7162 patients in whom stents were implanted. At 1 year, definite/probable ST occurred in 146 patients (2.2%), including 94 definite and 52 probable events. There were 100 episodes (1.4%) of early ST (within the first 30 days) and 46 episodes (0.8%) of late ST (between 30 days and 1 year). The incidence of ST within 1 year was similar in patients treated with drug-eluting stents or bare metal stents (hazard ratio, 0.86; 95% confidence interval, 0.62-1.20; P=0.38) and was independent of procedural antithrombotic treatment. Patients with ST compared with those without ST had strikingly higher 1-year rates of cardiac mortality (32.4% versus 2.9%, P<0.0001), myocardial infarction (82.6% versus 7.6%, P<0.0001), and target vessel revascularization (79.6% versus 7.4%, P<0.0001). Independent predictors of 1-year definite/probable ST were insulin-treated diabetes mellitus, number of diseased vessels, and ST-segment deviation ≥1 mm. Conclusions-Compared with elective stent implantation, ST occurs with increased frequency in the first year after stent implantation in patients with NSTE-ACS, especially within the first 30 days, and is associated with marked increases in cardiac mortality and adverse events. Insulin-treated diabetes, number of diseased vessels, and dynamic ST-segment changes were independent predictors of 1-year ST in NSTE-ACS.

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