The outcome of primary percutaneous coronary intervention in patients with stent thrombosis

Background: Primary percutaneous coronary intervention (PCI) is a recommended management strategy for patients with de novo ST-segment elevation myocardial infarction (STEMI). Still, the efficacy of primary PCI in-stent thrombosis (ST) induced STEMI is unclear. The aim was to assess the clinical characteristics and the in-hospital outcomes of patients undergoing primary PCI for STEMI caused by acute, sub-acute, or late ST. Methods: A sample of hundred consecutive patients who presented with STEMI due to ST were included in this study. The angiographic evidence of a flow-limiting thrombus or total vessel occlusion (thrombolysis in myocardial infarction (TIMI) flow grade 0 to II) at the site of the previous stent implant was taken as ST. Primary PCI was performed, and all enrolled patients and in-hospital mortality were observed. Results: Male patients were 69, and the mean age was 58.9 ± 7.78 years. ST was categorized as acute in 40 patients, sub-acute in 53, and late in the remaining seven patients. Killip class III/IV was observed in 45 patients. Dissection was observed in 25, under deployment in 74, and/or malposition in 24 patients. Thrombus aspiration was performed in 97, plain old balloon angioplasty in 76, and stenting in 22 patients. Final TIMI III flow was achieved in 32 patients. During a mean hospital stay of 4.93 ± 2.46 days, the mortality rate was 27%. Conclusion: In-hospital mortality after primary PCI was observed in more than 1/4th of the patients with STEMI due to ST undergoing primary PCI

Trombosis muy tardía de stent metálico convencional: Un suceso inesperado

RESUMEN La trombosis muy tardía de stent es un fenómeno de baja frecuencia, pero de elevada morbilidad y mortalidad. Dentro de sus factores predisponentes se encuentran parámetros clínicos, anatómicos y relacionados con el procedimiento. Múltiples son los mecanismos fisiopatológicos que se plantean como responsables de la trombosis de stent. El tratamiento de esta complicación consiste en intentar restaurar el flujo del vaso lo antes posible. Se presenta el caso de un paciente con el diagnóstico de infarto agudo de miocardio con elevación del segmento ST secundario a trombosis muy tardía de stent metálico convencional (20 meses), tratado exitosamente mediante intervencionismo coronario percutáneo con dos stents liberadores de sirolimus.

ABSTRACT Very late stent thrombosis is a rare complication but with high morbidity and mortality. Predisposing factors include clinical, anatomical and procedure-related parameters. Many pathophysiological mechanisms are considered to be responsible for stent thrombosis. The treatment of this complication consists of attempting to restore blood flow as soon as possible. We present the case of an individual diagnosed with ST-segment elevation myocardial infarction after very late thrombosis of conventional bare metal stent (20 months). The patient was successfully treated by percutaneous coronary intervention with two sirolimus-eluting stents.

Persistent mycotic superficial femoral artery pseudoaneurysm after endovascular treatment: a case report / Pseudoaneurisma micótico persistente da artéria femoral superficial após tratamento endovascular: relato de caso

Abstract Mycotic pseudoaneurysms of the superficial femoral artery (SFA) are rare and are usually secondary to colonization of an atherosclerotic plaque during an episode of bacteremia. We describe the case of a 68 year-old diabetic male who presented to the Emergency Department with pyrexia and a painful expanding mass in the left thigh. He had a history of diarrhea and had been treated 16 days earlier for an SFA pseudoaneurysm that had been excluded with a covered stent with no adjunctive antibiotic therapy. Angio CT showed an abscess surrounding femoral vessels and stent thrombosis. Under general anesthesia, we performed extensive debridement, removal of the endovascular material, SFA ligation, and empirical antibiotic therapy. Blood and tissue cultures were positive for Escherichia coli. At the 3-months follow up visit, the patient reported he had no claudication. In selected patients, mycotic pseudoaneurysms can be treated by SFA ligation.

Resumo Pseudoaneurismas micóticos da artéria femoral superficial (AFS) são raros, e geralmente são secundários à colonização de uma placa aterosclerótica durante bacteremia. Relatamos o caso de um paciente masculino diabético de 68 anos que chegou ao Serviço de Emergência com pirexia e massa expansiva dolorosa na coxa esquerda. Apresentava histórico de diarreia e havia sido tratado 16 dias antes para pseudoaneurisma da AFS, que foi excluído com stent coberto e sem antibioticoterapia adjuvante. A angiotomografia computadorizada demonstrou um abscesso ao redor dos vasos femorais e trombose do stent. Sob anestesia geral, realizamos desbridamento extenso, remoção do material endovascular, ligadura de AFS e antibioticoterapia empírica. Culturas de sangue e tecidos foram positivas para Escherichia coli. Na consulta de seguimento aos 3 meses, o paciente negou claudicação. Em pacientes selecionados, pseudoaneurismas micóticos podem ser tratados com ligadura de AFS.

Analysis of risk factors for early stent thrombosis in the Chinese population: A multicenter restrospective study / 世界急诊医学杂志（英文）

@#BACKGROUND: The predictive scoring systems for early stent thrombosis (EST) remains blank in China. The study aims to evaluate the risk factors and conduct a prediction model of EST in the Chinese population. METHODS: EST was defined as thrombosis that occurs within the first 30 days after primary percutaneous coronary intervention (PCI). Patients from ten Chinese hospitals diagnosed as stent thrombosis (ST) from January 2010 to December 2016 were retrospectively included as the study group. A control group (1 case:2 controls) was created by including patients without ST, major adverse cardiovascular events, or cerebrovascular events during follow-up. The present study evaluated 426 patients with single-vessel lesions and ultimately included 40 patients with EST and 80 control patients, who were included to identify factors that predicted EST and to develop a prediction scoring system. The other 171 patients without integrated 1:2 pair were used for external validation. RESULTS: EST was independently associated with a low hemoglobin concentration (adjusted odds ratio [OR] 0.946, 95% confidence interval [95% CI] 0.901-0.993, P=0.026), a high pre-PCI Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (OR 1.166, 95% CI 1.049-1.297, P=0.004), and a DAPT (DAPT) duration of <30 days (OR 28.033, 95% CI 5.302-272.834, P<0.001). The simple EST prediction score provided an area under the curve (AUC) of 0.854 (95% CI 0.777-0.932, P<0.001) with 70.0% sensitivity and 90.0% specificity, and 0.742 (95% CI 0.649-0.835, P<0.001) with 54.5% sensitivity and 81.0% specificity for external validation dataset. CONCLUSIONS: EST may be independently associated with DAPT discontinuation within 30 days, a low hemoglobin concentration, and a high SYNTAX score. The scoring system also has a good ability to predict the risk of EST and may be useful in the clinical setting.

Systemic thrombolysis with tenecteplase in stent thrombosis patients as a life saving measure in odd situations: an observational study from tertiary care hospital

Background: Coronary artery stent thrombosis specifically acute stent thrombosis is always a nightmare for interventionist. Stent thrombosis is one of a severe and catastrophic complication of percutaneous coronary intervention (PCI). Repeat PCI is commonly considered the preferred strategy to manage patients with stent thrombosis. Thrombolytic therapy is considered only partially effective.Methods: This was a single centre largest ever observational study on this topic comprising of total 110 patients with history of previous stent implantation and now presented with an acute ST segment elevation myocardial infarction due to a probable stent thrombosis successfully treated with systemic thrombolysis with tenecteplase were studied over the period of 2 years (April 2017 to March 2019).Results: On analyzing data clinical success was reported in 92 (83.6%) patients, electrocardiographic success is seen in 102 (92.7%) patients while angiographic success was reported in 80(72.7%) patients. Cerebrovascular accident were reported in 2 (1.8%) patients which died later on.Conclusions: This study which is the first ever largest observational study on this topic demonstrates that, in patients with probable stent thrombosis and a short time to reperfusion in some specific extraordinary situations where timely percutaneous coronary intervention is not possible, systemic thrombolysis by fibrin specific Tenecteplase can be done as a life saving procedure which is associated with good immediate results.

Definite stent thrombosis among Malaysian population: predictors and insights of mechanisms from intracoronary imaging

@#Introduction: Stent thrombosis (ST) is an uncommon, but significant complication following angioplasty. We aimed to examine the predictors, clinical outcomes and mechanism of definite ST cases among patients who underwent percutaneous coronary intervention (PCI). Methods: This was a retrospective observational registry of 14,935 patients from the year 2011 till 2015. Clinical characteristics, clinical outcome and intracoronary imaging data were recorded in all the patients. The SPSS Statistic version 24 was used for statistical analysis. The Cox regression hazard model was used to report calculate the hazard ratio (HR) with a 95% confidence interval (95%CI). Independent predictors of ST were identified by univariate logistic regression analysis. Variables that showed a statistically significant effect in univariate analyses were entered in a multivariate Cox proportional hazards model. A p-value<0.05 was regarded as significant. Results: The incidence of definite ST was 0.25% (37 out of 14935 patients). 75% of ST group patients presented with ST elevation myocardial infarction (75% vs. 19.8%, p<0.01). There was higher mortality among patients with ST when compared to the group without ST (Hazard Ratio, HR=10.69, 95%CI: 1.13, 100). Two independent predictors of ST were 1) previous history of acute myocardial infarction (HR=2.36, 95%CI: 1.19, 4.70) and 2) PCI in the context of acute coronary syndrome when compared to elective PCI (HR=37, 95%CI: 15.7, 91.5). Examination of 19 ST cases with intracoronary imaging identified nine cases (47%) of underexpanded stents and five cases (26%) of malopposition of stents. Conclusions: ST is associated with high mortality. PCI in acute coronary syndrome setting and a previous history of acute myocardial infarction were significant predictors for ST. Intracoronary imaging identified stent underexpansion and malopposition as common reasons for ST. In cases where the risk of ST is high, the use of intracoronary imaging guided PCI is recommended.

Effect of morphine use on oral P2Y12 platelet inhibitors in acute myocardial infarction: Meta-analysis

Background Morphine is the recommended analgesic in acute myocardial infarction (AMI). This recommendation has come under scrutiny because of possible slow uptake of oral antiplatelet agents. Objective We performed a meta-analysis of all available studies in AMI patients treated with prasugrel or ticagrelor (P2Y12 inhibitors) that reported use of morphine prior to loading the antiplatelet agents to critically assess the safety of co-administration of morphine and the newer P2Y12 inhibitors. Methods Several sources were searched from inception to December 2017 with inclusion of eight studies, largely observational. Mean difference (MD) was calculated for continuous variables, and standardized mean difference (SMD) for platelet function was assessed by the various platelet assays, 2 h after the loading dose of oral P2Y12 inhibitors. Results Higher platelet activity was noted among morphine group [SMD = 0.8, 95% confidence interval (CI) = 0.4–1.1, p < 0.01]. Morphine use caused higher odds of “high residual platelet reactivity” at 2 h (odds = 3.3, 95 %CI = 2.2–5.1, p < 0.01). Ticagrelor reached a lower plasma concentration in morphine group (MD = −481.8 ng/ml, 95% CI = −841.2 to −122.4 ng/ml, p < 0.01) with a higher vomiting rate (odds = 5.3, 95% CI = 2.5–11.1, p < 0.01). However, the composite of in-hospital mortality, stroke, and re-infarction was not significantly different between the groups (p = 0.83). Conclusion Co-administration of morphine with P2Y12 inhibitors possibly decreases their efficacy in platelet inhibition. However, this did not translate into higher adverse outcomes because of low event rates, inadequate for analysis. A large randomized study is needed to evaluate the narcotic-P2Y12 interaction.

Comparison of clinical outcomes regarding the use of titanium-nitride-oxide-coated stents (Titan) versus zotarolimus-eluting stents (Endeavor) in patients with ST-segment elevation myocardial infarction (STEMI): An experience from a Cardiac Center-Third care level / Comparación de los resultados clínicos con respecto al uso de stents recubiertos de óxido de titanio (Titan) versus stents liberadores de zotarolimus (Endeavor) en pacientes con infarto de miocardio por elevación del segmento ST (STEMI): Una experiencia de un centro cardiaco de Tercer nivel de atención

Abstract: Introduction: Internationally, the Titan bioactive stent efficacy and safety have been evaluated against second-generation drug-eluting stents (DES) in patients with acute coronary syndrome. In our field, however, there is not enough information about its short-term or one-year follow-up outcomes when compared with a second-generation drug-eluting stent in ST-segment elevation myocardial infarction (STEMI). Objective: To evaluate and compare immediate, in-hospital and one-year use clinical outcomes of the Titan stent versus Endeavor stent in patients with ST-segment elevation myocardial infarction. Material and methods: A descriptive, comparative, longitudinal, retrospective, observational study was performed in patients with ST-segment elevation myocardial infarction type acute coronary syndrome who were subjected to primary, pharmacoinvasive and rescue angioplasties, using a Titan stent against Endeavor stent. Primary points: major adverse cardiac events (MACEs), death, myocardial infarction, need for target lesion revascularization (TLR), target vessel revascularization (TVR), cerebrovascular event (CVE) and stent thrombosis. Secondary points: Dual antiplatelet therapy (DAPT) usage time. Results: 256 patients with ST-segment elevation myocardial infarction were examined from January 2011 to December 2014. They were treated with a Titan bioactive stent (135 patients) or Endeavor stent (121 patients). There were no significant differences related to major adverse cardiac events, death, myocardial infarction, stent thrombosis or cerebrovascular event, either in-hospital or one-year follow-up. More patients were observed in the Killip-Kimball 3-4 classification in Endeavor stent group versus patients in Titan stent group (62.2% versus 42.2%, respectively, p = 0.010). A greater pre-PTCA (Percutaneous Transluminal Coronary Angioplasty) TIMI (Thrombolysis in Myocardial Infarction) 0-1 flow rate was also observed (90.9% in Endeavor stent group versus 79.3% in Titan stent group, p = 0.010). However, the Titan stent was considerably more used in elderly patients (62.36 ± 12.95 years old versus 57.59 ± 10.42 years old in Endeavor stent group, p = 0.001); in more complex type C lesions (62.4% in Titan stent group versus 40.5% in Endeavor stent group, p = 0.010); and small vessels (28.9% in Titan stent group versus 18.2% in Endeavor stent group, p = 0.045). Target lesion revascularization and target vessel revascularization rates were similar: 0% versus 2.5%, p = 0.066 and 0% versus 0.8%, p = 0.290, in Titan stent and Endeavor stent groups, respectively. There were no significant differences on the major adverse cardiac events-free survival analysis (Log-rank Mantel-Cox 0.764 test). There were significant differences on dual antiplatelet therapy usage time (6.46 ± 4.11 months in Titan stent group versus 10.98 ± 2.51 months in Endeavor stent group, p ≤ 0.0001). Conclusions: There was no superiority registered in use of a second-generation drug-eluting stent such as the Endeavor stent versus Titan bioactive stent (titanium-nitride-oxide-coated stent) in patients with ST-segment elevation myocardial infarction regarding immediate, in-hospital and one-year follow-up clinical outcomes. The Titan stent seems to be a good choice for this kind of ST-segment elevation acute coronary syndrome in both efficacy and safety against new drug-eluting stents, and it could be used in elderly patients and/or patients with high bleeding risk requiring less time of dual antiplatelet therapy.(AU)

Resumen: Introducción: A nivel internacional, la eficacia y la seguridad de los stents bioactivos Titan se han evaluado en comparación con los stents liberadores de fármacos (su sigla en inglés es DES) de segunda generación en pacientes con síndrome coronario agudo. Sin embargo, en nuestro campo, no hay suficiente información acerca de sus resultados de seguimiento a corto plazo o de un año cuando se compara con una endoprótesis liberadora de fármacos de segunda generación en el infarto de miocardio por elevación del segmento ST (STEMI). Objetivo: Evaluar y comparar los resultados clínicos inmediatos, en el hospital y a un año de uso del stent Titan frente a stent Endeavor en pacientes con infarto de miocardio por elevación del segmento ST. Material y métodos: Se realizó un estudio observacional descriptivo, comparativo, longitudinal, retrospectivo y observacional en pacientes con el síndrome coronario agudo de infarto de miocardio por elevación del segmento ST que fueron sometidos a angioplastias primarias, farmacoinvasivas y de rescate, utilizando un stent Titan contra el stent Endeavor. Puntos primarios: eventos cardiacos adversos mayores (MACE), muerte, infarto de miocardio, necesidad de revascularización de la lesión objetivo (TLR). Revascularización del vaso objetivo (TVR), evento cerebrovascular (CVE) y trombosis del stent. Puntos secundarios: Tiempo de uso de la terapia antiplaquetaria dual (DAPT). Resultados: De enero de 2011 a diciembre de 2014 se examinaron 256 pacientes con infarto de miocardio por elevación del segmento ST. Fueron tratados con un stent bioactivo de Titan (135 pacientes) o un stent de Endeavor (121 pacientes). No hubo diferencias significativas relacionadas con los eventos cardiacos adversos mayores, muerte, infarto de miocardio, trombosis de stent o evento cerebrovascular, ni en el hospital ni en el seguimiento de un año. Se observaron más pacientes en la clasificación Killip-Kimball 3-4 en el grupo de stent Endeavor versus pacientes en el grupo de stent Titan (62.2% versus 42.2%, respectivamente, p = 0.010). También se observó una mayor tasa de flujo 0-1 antes de la PTCA (angioplastia coronaria transluminal percutánea) TIMI (trombólisis en el infarto de miocardio) (90.9% en el grupo de stent Endeavor frente a 79.3% en el grupo de stent Titan, p = 0.010). Sin embargo, la endoprótesis Titan se utilizó considerablemente más en pacientes de edad avanzada (62.36 ± 12.95 años frente a 57.59 ± 10.42 años en el grupo de endoprótesis Endeavor, p = 0.001); en las lesiones tipo C más complejas (62.4% en el grupo de stent Titan versus 40.5% en el grupo de stent Endeavor, p = 0.010); y en pequeños vasos (28.9% en el grupo de stent Titan versus 18.2% en el grupo de stent Endeavor, p = 0.045). La revascularización de las lesiones objetivo y las tasas de revascularización de los vasos objetivo fueron similares: 0% versus 2.5%, p = 0.066 y 0% versus 0.8%, p = 0.290, en los grupos de stent Titan y stent Endeavor, respectivamente. No hubo diferencias significativas en el análisis de supervivencia sin eventos cardiacos adversos mayores (ensayo de Mantel-Cox 0.764 del rango de logos). Hubo diferencias significativas en el tiempo de uso del tratamiento antiplaquetario dual (6.46 ± 4.11 meses en el grupo con stent Titan versus 10.98 ± 2.51 meses en el grupo con stent Endeavor, p ≤ 0.0001). Conclusiones: No se registró una superioridad en el uso de un stent liberador de fármacos de segunda generación como el stent Endeavor versus el stent bioactivo Titan (stent recubierto de titanio-nitrurado) en pacientes con infarto de miocardio por elevación del segmento ST con respecto a los resultados clínicos de seguimiento inmediato, hospitalario y de un año. El stent Titan parece ser una buena opción para este tipo de síndrome coronario agudo por elevación del segmento ST, tanto en eficacia como en seguridad frente a nuevos stents liberadores de fármacos, y podría utilizarse en pacientes ancianos y/o pacientes con alto riesgo de hemorragia que requieran menos tiempo de tratamiento antiplaquetario dual.(AU)

Antiplatelet Therapy, Clinical Characters and Long-term Outcomes of Patients With Angiography-documented Stent Thrombosis / 中国循环杂志

Objectives: To describe the differences between patients with angiography confirmed stent thrombosis in antiplatelet therapy and long term outcomes. Methods: We analyzed data from 1 204 patients with angiography – documented stent thrombosis between January 2008 to December 2016 in Beijing Anzhen Hospital. According to the timing of stent thrombosis post stent implantation, patients were divided into acute stent thrombosis (<24 h, n=106), subacute stent thrombosis(24 h~30 d, n=206), late stent thrombosis (>30 d~1y, n=268), and very late stent thrombosis (>1 y, n=624) groups. Death, recurrent stent thrombosis, recurrent myocardial infarction, target vessel revascularization, stroke and antiplatelet treatment during In-hospital or long-term clinical follow-up were compared among groups. Results: Prevalence of stent thrombosis was the highest in the left anterior descending artery (51.9%) in acute stent thrombosis group. Subjects with subacute stent thrombosis had a higher prevalence rate of LVEF<50% (28.2%), and subjects with very late stent thrombosis had a higher prevalence rate of diabetes (34.1%). All patients in acute stent thrombosis group received aspirin + clopidogrel, 96.5% patients in subacute stent thrombosis group and 94.5% patients in late stent thrombosis group were treated with double or triple antiplatelet therapy, while 95.2% patients in the very late stent thrombosis group were treated with double or mono antiplatelet therapy. During the follow up, mortality was 23.6%, 26.7%, 26.3% and 18.9% in acute stent thrombosis, subacute stent thrombosis, late stent thrombosis, and very late stent thrombosis groups, respectively. Conclusions: Most patients with angiography–documented stent thrombosis are treated with recommended antiplatelet therapy. Development of stent thrombosis is associated with poor outcomes.

Comparison of Efficacy and Safety between First- and Second-Generation Drug-Eluting Stents in Patients with Acute Coronary Syndrome / 中华医学杂志(英文版)

Background@#It remains undetermined whether second-generation drug-eluting stents (G2-DESs) outperform first-generation DESs (G1-DESs) in patients with acute coronary syndrome (ACS). We aimed to compare the efficacy and safety of G1-DES and G2-DES in ACS patients in a high-volume cardiovascular center.@*Methods@#In 2013, 10,724 consecutive patients underwent percutaneous coronary intervention in our institution. We included 4037 patients with ACS who underwent exclusively G1-DES or G2-DES implantation (n = 364 and n = 3673, respectively). We used propensity score matching to minimize the imbalance between the G1-DES and G2-DES groups and followed patients for 2 years. The efficacy endpoints were major adverse cardiac events (MACEs) and its components including target vessel-related myocardial infarction (TV-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), and cardiac death. The safety endpoint was stent thrombosis. Continuous variables were compared by Mann-Whitney U-test, and categorical variables were compared using Pearson's Chi-square or Fisher's exact test. Kaplan-Meier curves were constructed to compare the event-free survival rates, and multivariate Cox proportional hazards regression analysis was used to assess whether stent type was an independent risk factor for the efficacy and safety endpoints.@*Results@#At the 2-year follow-up, the results for MACE and it components, as well as stent thrombosis, were similar for G1-DES and G2-DES (MACE, 5.2% vs. 4.3%, χ = 0.514, P = 0.474; TV-MI, 0.8% vs. 0.4%, P = 0.407; TVR, 4.9% vs. 3.7%, χ = 0.939, P = 0.333; TLR, 3.8% vs. 2.5%, χ = 1.610, P = 0.205; cardiac death, 0.3% vs. 0.5%, P = 0.670; and stent thrombosis, 0.5% vs. 0.4%, P > 0.999). Kaplan-Meier analysis indicated similar event-free survival rates between G1-DES and G2-DES after propensity score matching (all: log-rank P > 0.05). Multivariate analysis demonstrated that stent type was not an independent risk factor for the efficacy and safety endpoints (MACE, hazard ratio [HR] = 0.805, 95% confidence interval [CI]: 0.455-1.424, P = 0.456; TV-MI, HR = 0.500, 95% CI: 0.101-2.475, P = 0.395; TVR, HR = 0.732, 95% CI: 0.403-1.330, P = 0.306; TLR, HR = 0.629, 95% CI: 0.313-1.264, P = 0.193; cardiac death, HR = 1.991, 95% CI: 0.223-17.814, P = 0.538; and stent thrombosis, HR = 0.746, 95% CI: 0.125-4.467, P = 0.749).@*Conclusion@#G1-DES and G2-DES have similar efficacy and safety profiles in ACS patients at the 2-year follow-up.

Clinical Comparison Between Very-late Stent Thrombosis and Very-late In-stent Restenosis / 中国循环杂志

Objective: To compare the clinical features between very late stent thrombosis (VLST) and very late in-stent restenosis, to discuss the potential risk factors for VLST occurrence. Methods: Our research included in 2 groups: VLST group, 21 ACS patients with coronary angiography (CAG) confirmed VLST admitted in our hospital and Control group, 38 ACS patients with CAG confirmed very late in-stent restenosis at same period of time. Basic clinical data, laboratory tests and relevant examinations were compared between 2 groups; potential risk factors for VLST occurrence were studied by Logistic regression analysis. Results: ① There were 8 (38.1%) patients discontinued anti-platelet therapy in a month by themselves in VLST group and 5 (13.2%) in Control group, P=0.03. ② 13 (61.9%) patients presented as ST-segment elevation myocardial infarction (STEMI) in VLST group, while all (100%) patients presented as Non-ST-segment elevation ACS (NST-ACS) in Control group, P<0.001. ③ The age, gender, previous histories of hypertension, diabetes, MI, smoking and interventional therapy were similar between 2 groups, P>0.05. ④ Compared with Control group, VLST group had decreased LVEF, P=0.001, increased peak values of TnI and NT-pro BNP, elevated WBC and hs-CRP, all P<0.001. ⑤ The index of echocardiography, blood lipid profiles, glucose and creatinine were similar between 2 groups, P>0.05. ⑥ Logistic regression analysis showed that discontinued anti-platelet therapy, elevated NT-pro BNP and hs-CRP were the independent risk factors for VLST occurrence, P<0.05. Conclusion: VLST may have life-threatening clinical features, insisted anti-platelet therapy and improved cardiac function could reduce VLST occurrence.

Individualized Antiplatelet Therapy Analysis and Pharmaceutical Care for a Patient with Subacute Stent Thrombosis after PCI / 中国药房

OBJECTIVE:To investigate the role of clinical pharmacists in individualized antiplatelet therapy for a patient with subacute stent thrombosis after PCI.METHODS:Clinical pharmacists participated in the therapy for a myocardial infarction patient with diabetes,and the patient suffered from subacute stent thrombosis at the fourth day after PCI.Clinical pharmacists suggested performing clopidogrel-related gene detection [Cytochrome P450(CYP)2C19] through comprehensively analyzing the complexity of the lesion,the time of stent thrombosis,the number of stent implantations and combined diseases,etc.According to detection result (CYP2C19* 1/*2),clinical pharmacists suggested to additionally use Cilostazol tablets 50 mg,po,bid,on the basis of previous dual antiplatelet therapy;additionally use Alprostadil injection 10 μg,ivgtt,qd to improve microcirculation.Pharmaceutical care as therapeutic evaluation,ADR monitoring were performed,and medication education as medication notes and dietary adjustments were also provided.RESULTS:Physicians adopted the suggestions of clinical pharmacists;the patient was recovered and discharged from hospital.After discharge,the disease condition kept stable due to persistent aspirin+clopidogrel+cilostazol triple antiplatelet therapy.CONCLUSIONS:Drug metabolizing enzyme is an important cause of individual differences in antiplatelet effects and toxicity,and its gene polymorphism is closely related with clinical outcome and terminal event.Clinical pharmacists should play professional skill to assist physician to access and interpret relevant information,and formulate and adjust individualized antiplatelet therapy after considering disease condition,combined diseases and genotypes,so as to guarantee safe and effective drug use.

Coronary Stent Infection Presented as Recurrent Stent Thrombosis

Percutaneous transluminal coronary angioplasty with metal stent placement has become a well-developed treatment modality for coronary stenotic lesions. Although infection involving implanted stents is rare, it can, however, occur with high morbidity and mortality. We describe herein a case of an inserted coronary stent that was infected and complicated with recurrent stent thrombosis, pseudoaneurysm formation and severe sepsis. Despite repeated intervention and bypass surgery, the patient died from severe sepsis.

Treatment analysis and pharmaceutical care for one left subclavian artery after stent implantation in patients with stent thrombosis / 中国药学杂志

OBJECTIVE: To provide reference for the clinical pharmacists participating in the treatment of artery stent implantation in patients with stent thrombosis. METHODS: Through participating in the course of treatment for an artery stent implantation in patients with stent thrombosis, combining with the disease characteristics of the patient, medication history and adverse drug reactions, clinical pharmacist suggested that doctors should select appropriate drugs for the patient, and the patient should be provided with individualized pharmaceutical care. RESULTS: Clinical pharmacists use pharmacy expertise, with genetic testing and other means to assist clinicians for patients to develop individualized dosing regimen to protect the patients medication safety. CONCLUSION: Clinical pharmacists have their own advantages in providing individualized pharmaceutical care for patients. They play an important role in the rational use of drugs.

Simultaneous Multivessel Acute Stent Thrombosis in a Patient with Gastrointestinal Bleeding / 대한내과학회지

Stent thrombosis is a rare, but potentially catastrophic complication of stent implantation. Dual antiplatelet therapy with aspirin and a thienopyridine (clopidogrel, prasugrel, or ticagrelor) is essential to minimize the risk of stent thrombosis in patients receiving drug-eluting stents. However, there is an ongoing debate regarding antiplatelet therapy in patients presenting with acute coronary syndrome and bleeding. Here, we report a case of a 59-year-old man with acute stent thrombosis immediately after percutaneous coronary intervention combined with acute coronary syndrome and gastrointestinal bleeding.

An Intra-procedural Stent Thrombosis in a Prasugrel Resistant Patient Treated with Ticagrelor / 계명의대학술지

Stent thromboses due to multifactorial causes including hypercoagulable conditions and high on treatment platelet reactivity (HTPR), which means a low response to anti-platelet therapy, especially clopidogrel. Prasugrel is a third generation thienopyridine and inactive pro-drug requiring metabolic activation in vivo, which improves the rate of HTPR with clopidogrel. This drug is mostly effective, with a potent, fast, and consistent anti-platelet action, but rare cases of inadequate platelet inhibition with prasugrel have been reported. Here we describe the case of a 47-year-old man who presented with a recurrent acute myocardial infarction and ST during an intravascular ultrasound pullback and was resistant to prasugrel, was successfully treated with ticagrelor.

Trombosis de la endoprótesis vascular (stent)actualización para el médico clínico / Stent thrombosis: update for the clinician

La introducción de las endoprótesis vasculares (stents) ha reducido notablemente el riesgo de reestenosis en pacientes sometidos a intervención coronaria percutánea (ICP). Estos pueden ser metálicos (barestents, BS) o liberadores de fármacos (drugelutingstents, DES), dentro de Los cuales podemos encontrar DES de primera y segunda generación. Luego de la colocación del stent, se prescribe terapia antiplaquetaria con aspirina y un inhibidor P2Y12 por un año como mínimo. Sin embargo, es posible que ocurra una trombosis de stent (TS), la cual es una emergencia médica y obliga a que et paciente en la cual se produce, sea sometido a una coronariografía de emergencia.

The use of stent implantation, had dramatically diminished the risk of restenosis in patients submitted to coronary interventions. These could be bare stents (BS) or drug eluting stents (DES). We can also find DES from first and second generations. After stent placement, we must prescribe antiplatelet therapy including aspirin and a P2Y 12 inhibitor, at least for one year. However, it is possible the occurrence of a stent thrombosis (ST), which is a medical emergency and where an emergency coronary procedure must be indicated.

Individualized antiplatelet therapy on one patient with stent thrombosis after percutaneous coronary intervention by clinical pharmacist / 中国药学杂志

OBJECTIVE: To evaluate the role of clinical pharmacist in individualized antiplatelet therapy in patients with percutaneous coronary intervention (PCI). METHODS: To review clinical pharmacist participating antiplatelet therapy based on genotype detection for one patient with stent thrombosis after PCI. RESULTS: Clinical pharmacist analyzed the causes of stent thrombosis after PCI by genotype detection, participated the adjustment of antiplatelet therapy and implemented pharmaceutical care and pharmaceutical education for the patient in order to ensure the safety and effectiveness of drug use. CONCLUSION: Clinical pharmacist participates making and regulating the therapeutic regimen to provide some evidences for individualized medication, which could be the entry points to pharmaceutical care.

Relationship between the Obstructive Sleep Apnea-hypopnea Syndrome and the Stent Thrombosis / 实用医学杂志

Objective To investigate the relationship between stent thrombosis and obstructive sleep apnea-hypopnea syndrome (OSAHS) in patients after coronary artery stent implantation (CASI). Methods One hundred and seventeen patients were rolled after CASI, of which 29 suffering from OSAHS were enrolled into the research group, 88 patients without OSAHS were enrolled into the control group. The incidence rate of stent thrombosis between the above two groups was analyzed. Results Three patients suffered stent thrombosis in the research group, with the incidence rate of 10.3%,which was significantly higher than that in the control group, with the incidence rate of 1.10%(P = 0.047). Conclusions After CASI, patients with OSAHS had higher risk of stent thrombosis compared with patients without OSAHS. OSHAS should be considered as a risk factor for stent thrombosis.

Stent thrombosis and major clinical events after BuMA coronary stent implantation / 天津医药

Objective To investigate the long-term safety and efficacy of the domestic biodegradable drug-eluting cor?onary stents (BuMA) in treating coronary heart disease (CHD). Methods Patients (n=440) who received BUMA stents were designated as observation group while patients (n=460) received Resolutestents were designated as control group. The base?line clinical characteristics, extend of pathological change shown by Coronary Arteriography (CAG),the procedure of percu?taneous coronary intervention were similar between these two groups. The patients were followed up for a mean of 24 ± 4 months;the primary endpoint was the occurrence of definite or probable stent thrombosis;secondary endpoint was major ad?verse cardiac events (MACEs) including complex end such as recurrent angina, acute non-fatal myocardial infarction, death, target vessel revascularization (TVR); other endpoints include all- cause mortality, cardiac death, myocardial infarc?tion (MI), target lesion revascularization (TLR), non-target vessel revascularization and stroke. Some patients were lost dur?ing follow up, which include 5 in observation group and 26 in control group. Results Patients in observation groups were in?serted with 615 stents while patients in control group were implanted with 614 stents, both groups with average of implanting 1.41 stent/case. There are no statistical significance differences in the primary endpoint [1.4%(6/435) vs 1.8%(8/434), χ2=0.087], secondary endpoint [12.3%(54/435) vs 10.8%(47/434),χ2=0.524] and other endpoints between the two groups. Con?clusion These data suggest that domestic biodegradable drug-eluting coronary stents (BuMA) are with good long-term safe?ty and efficacy.