INCIDENCE AND PREDICTORS OF STENT THROMBOSIS IN 2023: A RETROSPECTIVE COHORT STUDY
Main Article Content
Keywords
stent thrombosis, drug-eluting stents, dyslipidemia, coronary intervention, retrospective study
Abstract
Background: Stent thrombosis remains a serious complication of coronary stent implantation and has significant implications for morbidity and mortality. Despite advancements in drug-eluting stent (DES) and antiplatelet therapies, the incidence of stent thrombosis persists, particularly among patients with specific demographic and clinical risk factors.
Objective: This study aimed to determine the incidence of stent thrombosis within six months of implantation and identify key predictors for enhancing clinical management strategies.
Methods: A retrospective cohort study was conducted at a tertiary care hospital, analyzing 1,000 patients who underwent coronary stent implantation between January 1, 2023, and December 31, 2023. Data were extracted from the institutional electronic health records and included demographic, clinical, and procedural details. Multivariate logistic regression was used to identify independent predictors, and Kaplan-Meier survival analysis was used to assess time-to-event data.
Results: The incidence of stent thrombosis was 2.4% (N=24) within six months. Patients who developed thrombosis had a significantly lower mean BMI (25.6 ± 3.9) than those without thrombosis (27.5 ± 4.9; p=0.041p = 0.041p=0.041). Dyslipidemia (OR: 2.16, 95% CI: 1.22–3.85, p=0.008p = 0.008p=0.008) and tobacco use (OR: 1.89, 95% CI: 1.02–3.49, p=0.044p = 0.044p=0.044) were significant predictors. Kaplan-Meier survival analysis revealed significantly reduced survival probabilities in patients with dyslipidemia (p=0.014, p = 0.014; p=0.014).
Conclusion: This study highlights the role of modifiable risk factors, including dyslipidemia and tobacco use, in predicting stent thrombosis. Implementing comprehensive risk management strategies, such as lipid-lowering therapies and smoking cessation programs, is essential for mitigating complications. Further research is warranted to explore long-term outcomes and validate these findings in diverse populations.
References
2. Stone GW, Moses JW, Ellis SG, et al. Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. N Engl J Med. 2007;356(10):998-1008. doi:10.1056/NEJMoa067193
3. Mauri L, Hsieh WH, Massaro JM, et al. Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med. 2007;356(10):1020-1029. doi:10.1056/NEJMoa067423
4. Windecker S, Simon R, Bonilla LF, et al. Predictors of stent thrombosis in randomized trials of drug-eluting stents. Lancet. 2005;366(9480):11-19. doi:10.1016/S0140-6736(05)67609-6
5. Kirtane AJ, Gupta A, Iyengar S, et al. Safety and efficacy of drug-eluting and bare-metal stents. Circulation. 2009;119(24):3198-3206. doi:10.1161/CIRCULATIONAHA.108.833873
6. Byrne RA, Joner M, Kastrati A. Stent thrombosis and restenosis: Predictors and mechanisms. Nat Rev Cardiol. 2009;6(6):317-328. doi:10.1038/nrcardio.2009.41
7. Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: Data from a large two-institutional cohort study. Lancet. 2007;369(9562):667. doi:10.1016/S0140-6736(07)60314-6
8. Stojanovic M, Cupic VI. Effect and significance of hyperlipoproteinemia on stent thrombosis in patients with implanted drug-eluting stents: The 5-year follow-up study. Am J Med Sci. 2023. Available at: https://amjmedsci.org/retrieve/pii/S0002962921001828
9. Vorpahl M, Yazdani SK, Nakano M, et al. Pathobiology of stent thrombosis after drug-eluting stent implantation. Curr Pharm Des. 2010;16(36):4064. doi:10.2174/138161210794454879
10. Benowitz NL. Nicotine and coronary heart disease. Trends Cardiovasc Med. 1991;1(8):315. doi:10.1016/1050-1738(91)90068-P
11. Barua RS, Ambrose JA. Mechanisms of coronary thrombosis in cigarette smoke exposure. Arterioscler Thromb Vasc Biol. 2013;33(7):1460. doi:10.1161/ATVBAHA.112.300154
12. Räber L, Magro M, Stefanini GG, et al. Very late stent thrombosis of a newer-generation drug-eluting stent. Circulation. 2012;125(9):1110-1121. doi:10.1161/CIRCULATIONAHA.111.058560
13. Vilahur G, Ben‐Aicha S, Badimón L. New insights into the role of adipose tissue in thrombosis. Cardiovasc Res. 2017;113(9):1046. doi:10.1093/cvr/cvx086
14. Barale C, Russo I. Influence of cardiometabolic risk factors on platelet function. Int J Mol Sci. 2020;21(2):623. doi:10.3390/ijms21020623
15. Lüscher TF, Steffel J, Eberli FR, et al. Drug-eluting stent and coronary thrombosis. Circulation. 2007;115(8):1051. doi:10.1161/CIRCULATIONAHA.106.675934
16. Foley JD, Moliterno DJ. Contemporary occurrence of stent thrombosis in clinical practice: Better never than late. Catheter Cardiovasc Interv. 2012;79(4):557. doi:10.1002/ccd.24343
17. Tada T, Byrne RA, Simunovic I, et al. Risk of stent thrombosis among drug-eluting and bare-metal stents in patients with and without diabetes mellitus: A patient-level pooled analysis of randomized trials. J Am Coll Cardiol. 2013;61(19):2111-2118. doi:10.1016/j.jacc.2013.01.057
18. Lechner K, McKenzie AL, Kränkel N, et al. High-risk atherosclerosis and metabolic phenotype: The roles of ectopic adiposity, atherogenic dyslipidemia, and inflammation. Metab Syndr Relat Disord. 2020;18(4):176. doi:10.1089/met.2019.0115
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Dr Ali Raza
Assistant Professor Intervention Cardiology, Peshawar Institute of Cardiology
Dr Fahad Raja Khan
Fellow Intervention Cardiology, Peshawar Institute of Cardiology
Dr Seema Nazir
Fellow Intervention Cardiology, Peshawar Institute of Cardiology
Dr Nasir Farooq
Fellow Intervention Cardiology, Peshawar Institute of Cardiology
Dr Rahman Ullah
Fellow Intervention Cardiology, Peshawar Institute of Cardiology,
Dr Muhammad Wajahat Jan
Fellow Intervention Cardiology, Peshawar Institute of Cardiology