Aims: To investigate the efficacy and outcome of emergency percutaneous coronary interventions(PCI) in patients with stent thrombosis. Methods and results: Between 1995 and 2003, 6058 patients underwent bare-metal ste...Aims: To investigate the efficacy and outcome of emergency percutaneous coronary interventions(PCI) in patients with stent thrombosis. Methods and results: Between 1995 and 2003, 6058 patients underwent bare-metal stent implantation, of which 95(1.6%) patients suffered from stent thrombosis. The timing of stent thrombosis was acute in 10(11%), subacute in 61(64%), and late in 24(25%) patients. Procedural and clinical outcomes of emergency PCI for treatment of stent thrombosis were investigated. Emergency PCI was successful in 86(91%), complicated by death in 2(2%), and coronary artery bypass grafting in 2(2%) patients. Myocardial infarction occurred in 77(81%) patients with a peak creatine kinase level of 1466±1570 U/L. Left ventricular ejection fraction declined from 0.54±0.19 prior to 0.48±0.16(P< 0.05) at the time of stent thrombosis after emergency PCI. A 6 month major adverse clinical events comprised death(11%), reinfarction(16%), and recurrent stent thrombosis(12%) after emergency PCI. Multivariable logistic regression analysis identified the achievement of TIMI 3 flow(OR=0.1, CI 95%0.01-0.54, P< 0.001) and diameter stenosis< 50%(OR=0.06, CI 95%0.01-0.32, P< 0.001) during emergency PCI to be independently associated with a reduced risk of cardiac death. Recurrent stent thrombosis was independently predicted by the omission of abciximab(OR=4.3, CI 95%1.1-17.5). Conclusion: Emergency PCI for treatment of stent thrombosis effectively restores vessel patency and flow. Patients presenting with stent thrombosis are at risk for recurrent myocardial infarction and recurrent stent thrombosis.展开更多
文摘Aims: To investigate the efficacy and outcome of emergency percutaneous coronary interventions(PCI) in patients with stent thrombosis. Methods and results: Between 1995 and 2003, 6058 patients underwent bare-metal stent implantation, of which 95(1.6%) patients suffered from stent thrombosis. The timing of stent thrombosis was acute in 10(11%), subacute in 61(64%), and late in 24(25%) patients. Procedural and clinical outcomes of emergency PCI for treatment of stent thrombosis were investigated. Emergency PCI was successful in 86(91%), complicated by death in 2(2%), and coronary artery bypass grafting in 2(2%) patients. Myocardial infarction occurred in 77(81%) patients with a peak creatine kinase level of 1466±1570 U/L. Left ventricular ejection fraction declined from 0.54±0.19 prior to 0.48±0.16(P< 0.05) at the time of stent thrombosis after emergency PCI. A 6 month major adverse clinical events comprised death(11%), reinfarction(16%), and recurrent stent thrombosis(12%) after emergency PCI. Multivariable logistic regression analysis identified the achievement of TIMI 3 flow(OR=0.1, CI 95%0.01-0.54, P< 0.001) and diameter stenosis< 50%(OR=0.06, CI 95%0.01-0.32, P< 0.001) during emergency PCI to be independently associated with a reduced risk of cardiac death. Recurrent stent thrombosis was independently predicted by the omission of abciximab(OR=4.3, CI 95%1.1-17.5). Conclusion: Emergency PCI for treatment of stent thrombosis effectively restores vessel patency and flow. Patients presenting with stent thrombosis are at risk for recurrent myocardial infarction and recurrent stent thrombosis.
