Stent Thrombosis Patients Require Better Management

Stent thrombosis predicts failed coronary perfusion and distal embolization in STEMI patients

THURSDAY, June 19 (HealthDay News) -- ST-segment elevation myocardial infarction (STEMI) patients who have had stent thrombosis have more adverse events and poorer early clinical outcomes than de novo STEMI patients, and require better care to narrow the gap, according to a paper published in the June 24 issue of the Journal of the American College of Cardiology.

Tania Chechi, M.D., of the University of Florence in Italy, and colleagues compared treatment and outcomes of 115 stent thrombosis patients, of whom 92 presented with STEMI, and were compared to 98 patients with de novo STEMI. All patients underwent percutaneous coronary intervention and were evaluated for successful reperfusion and distal embolization. Follow-ups were conducted at six months to determine major adverse cardiovascular and cerebrovascular events (MACCE).

Patients with stent thrombosis and STEMI had higher distal embolization rates and, importantly, significantly lower reperfusion rates than those who presented with de novo STEMI, after adjusting for a higher risk profile, the researchers found. Stent-thrombosis STEMI patients also had higher in-hospital MACCE rates than the non-ST group (25.6 percent compared with 9.2 percent), although the differences almost disappeared when measured at the six-month follow-up (11.3 percent in the ST group versus 9.9 percent in the second group).

"Treatment of patients suffering episodes of stent thrombosis constitutes not only a medical emergency but also a uniquely challenging procedure. Currently, no information exists regarding the best interventional strategy for this entity, and most recommendations remain empirical," Fernando Alfonso, M.D., Ph.D., of the San Carlos University Hospital in Madrid, Spain, writes in an accompanying editorial. "Further studies are urgently required."

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