Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors ‐ a VALIDATE‐SWEDEHEART Substudy

Background The clinical importance of intraprocedural stent thrombosis (IPST) during percutaneous coronary intervention in the contemporary era of potent oral P2Y12 inhibitors is not established. The aim of this study was to assess IPST and its association with clinical outcome in patients with myoc...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Sofia Bergman, Moman A. Mohammad, Stefan K. James, Oskar Angerås, Henrik Wagner, Jens Jensen, Fredrik Scherstén, Ole Fröbert, Sasha Koul, David Erlinge
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	intraprocedural stent thrombosis myocardial infarction oral P2Y12 inhibitors percutaneous coronary intervention stent thrombosis Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/4c28dbdfe0e249449a24ae1364a208af
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:4c28dbdfe0e249449a24ae1364a208af
record_format	dspace
spelling	oai:doaj.org-article:4c28dbdfe0e249449a24ae1364a208af2021-11-23T11:36:35ZClinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors ‐ a VALIDATE‐SWEDEHEART Substudy10.1161/JAHA.121.0229842047-9980https://doaj.org/article/4c28dbdfe0e249449a24ae1364a208af2021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.022984https://doaj.org/toc/2047-9980Background The clinical importance of intraprocedural stent thrombosis (IPST) during percutaneous coronary intervention in the contemporary era of potent oral P2Y12 inhibitors is not established. The aim of this study was to assess IPST and its association with clinical outcome in patients with myocardial infarction undergoing percutaneous coronary intervention with contemporary antithrombotic medications. Methods and Results The VALIDATE‐SWEDEHEART study (Bivalirudin Versus Heparin in ST‐Segment and Non–ST‐Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial) included 6006 patients with myocardial infarction, treated with potent P2Y12 inhibitors during percutaneous coronary intervention. IPST, defined as a new or worsening thrombus related to a stent deployed during the procedure, was reported by the interventional cardiologist in 55 patients (0.9%) and was significantly associated with ST‐segment elevation myocardial infarction presentation, longer stents, bailout glycoprotein IIb/IIIa inhibitors, and final Thrombolysis in Myocardial Infarction flow <3. The primary composite end point included cardiovascular death, myocardial infarction, out‐of‐laboratory definite stent thrombosis and target vessel revascularization within 30 days. Secondary end points were major bleeding and the individual components of the primary composite end point. Patients with versus without IPST had significantly higher rates of the primary composite end point (20.0% versus 4.4%), including higher rates of cardiovascular death, target vessel revascularization, and definite stent thrombosis, but not myocardial infarction or major bleeding. By multivariable analysis, IPST was independently associated with the primary composite end point (hazard ratio, 3.82; 95% CI, 2.05–7.12; P<0.001). Conclusions IPST is a rare but dangerous complication during percutaneous coronary intervention, independently associated with poor prognosis, even in the current era of potent antiplatelet agents. Future treatment studies are needed to reduce the rate of IPST and to improve the poor outcome among these patients. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02311231.Sofia BergmanMoman A. MohammadStefan K. JamesOskar AngeråsHenrik WagnerJens JensenFredrik SchersténOle FröbertSasha KoulDavid ErlingeWileyarticleintraprocedural stent thrombosismyocardial infarctionoral P2Y12 inhibitorspercutaneous coronary interventionstent thrombosisDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	intraprocedural stent thrombosis myocardial infarction oral P2Y12 inhibitors percutaneous coronary intervention stent thrombosis Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	intraprocedural stent thrombosis myocardial infarction oral P2Y12 inhibitors percutaneous coronary intervention stent thrombosis Diseases of the circulatory (Cardiovascular) system RC666-701 Sofia Bergman Moman A. Mohammad Stefan K. James Oskar Angerås Henrik Wagner Jens Jensen Fredrik Scherstén Ole Fröbert Sasha Koul David Erlinge Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors ‐ a VALIDATE‐SWEDEHEART Substudy
description	Background The clinical importance of intraprocedural stent thrombosis (IPST) during percutaneous coronary intervention in the contemporary era of potent oral P2Y12 inhibitors is not established. The aim of this study was to assess IPST and its association with clinical outcome in patients with myocardial infarction undergoing percutaneous coronary intervention with contemporary antithrombotic medications. Methods and Results The VALIDATE‐SWEDEHEART study (Bivalirudin Versus Heparin in ST‐Segment and Non–ST‐Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial) included 6006 patients with myocardial infarction, treated with potent P2Y12 inhibitors during percutaneous coronary intervention. IPST, defined as a new or worsening thrombus related to a stent deployed during the procedure, was reported by the interventional cardiologist in 55 patients (0.9%) and was significantly associated with ST‐segment elevation myocardial infarction presentation, longer stents, bailout glycoprotein IIb/IIIa inhibitors, and final Thrombolysis in Myocardial Infarction flow <3. The primary composite end point included cardiovascular death, myocardial infarction, out‐of‐laboratory definite stent thrombosis and target vessel revascularization within 30 days. Secondary end points were major bleeding and the individual components of the primary composite end point. Patients with versus without IPST had significantly higher rates of the primary composite end point (20.0% versus 4.4%), including higher rates of cardiovascular death, target vessel revascularization, and definite stent thrombosis, but not myocardial infarction or major bleeding. By multivariable analysis, IPST was independently associated with the primary composite end point (hazard ratio, 3.82; 95% CI, 2.05–7.12; P<0.001). Conclusions IPST is a rare but dangerous complication during percutaneous coronary intervention, independently associated with poor prognosis, even in the current era of potent antiplatelet agents. Future treatment studies are needed to reduce the rate of IPST and to improve the poor outcome among these patients. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02311231.
format	article
author	Sofia Bergman Moman A. Mohammad Stefan K. James Oskar Angerås Henrik Wagner Jens Jensen Fredrik Scherstén Ole Fröbert Sasha Koul David Erlinge
author_facet	Sofia Bergman Moman A. Mohammad Stefan K. James Oskar Angerås Henrik Wagner Jens Jensen Fredrik Scherstén Ole Fröbert Sasha Koul David Erlinge
author_sort	Sofia Bergman
title	Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors ‐ a VALIDATE‐SWEDEHEART Substudy
title_short	Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors ‐ a VALIDATE‐SWEDEHEART Substudy
title_full	Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors ‐ a VALIDATE‐SWEDEHEART Substudy
title_fullStr	Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors ‐ a VALIDATE‐SWEDEHEART Substudy
title_full_unstemmed	Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors ‐ a VALIDATE‐SWEDEHEART Substudy
title_sort	clinical impact of intraprocedural stent thrombosis during percutaneous coronary intervention in patients treated with potent p2y12 inhibitors ‐ a validate‐swedeheart substudy
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/4c28dbdfe0e249449a24ae1364a208af
work_keys_str_mv	AT sofiabergman clinicalimpactofintraproceduralstentthrombosisduringpercutaneouscoronaryinterventioninpatientstreatedwithpotentp2y12inhibitorsavalidateswedeheartsubstudy AT momanamohammad clinicalimpactofintraproceduralstentthrombosisduringpercutaneouscoronaryinterventioninpatientstreatedwithpotentp2y12inhibitorsavalidateswedeheartsubstudy AT stefankjames clinicalimpactofintraproceduralstentthrombosisduringpercutaneouscoronaryinterventioninpatientstreatedwithpotentp2y12inhibitorsavalidateswedeheartsubstudy AT oskarangeras clinicalimpactofintraproceduralstentthrombosisduringpercutaneouscoronaryinterventioninpatientstreatedwithpotentp2y12inhibitorsavalidateswedeheartsubstudy AT henrikwagner clinicalimpactofintraproceduralstentthrombosisduringpercutaneouscoronaryinterventioninpatientstreatedwithpotentp2y12inhibitorsavalidateswedeheartsubstudy AT jensjensen clinicalimpactofintraproceduralstentthrombosisduringpercutaneouscoronaryinterventioninpatientstreatedwithpotentp2y12inhibitorsavalidateswedeheartsubstudy AT fredrikschersten clinicalimpactofintraproceduralstentthrombosisduringpercutaneouscoronaryinterventioninpatientstreatedwithpotentp2y12inhibitorsavalidateswedeheartsubstudy AT olefrobert clinicalimpactofintraproceduralstentthrombosisduringpercutaneouscoronaryinterventioninpatientstreatedwithpotentp2y12inhibitorsavalidateswedeheartsubstudy AT sashakoul clinicalimpactofintraproceduralstentthrombosisduringpercutaneouscoronaryinterventioninpatientstreatedwithpotentp2y12inhibitorsavalidateswedeheartsubstudy AT daviderlinge clinicalimpactofintraproceduralstentthrombosisduringpercutaneouscoronaryinterventioninpatientstreatedwithpotentp2y12inhibitorsavalidateswedeheartsubstudy
_version_	1718416761562333184

Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors ‐ a VALIDATE‐SWEDEHEART Substudy

Ejemplares similares