Comparison of outcomes after percutaneous coronary intervention among different coronary subsets (stable and unstable angina pectoris and ST-segment and non-ST-segment myocardial infarction).

MedStar author(s):
Citation: American Journal of Cardiology. 113(11):1794-801, 2014 Jun 1.PMID: 24837256Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal ArticleSubject headings: *Angina, Stable/su [Surgery] | *Angina, Unstable/su [Surgery] | *Electrocardiography | *Myocardial Infarction/su [Surgery] | *Percutaneous Coronary Intervention/mt [Methods] | *Stents | Aged | Angina, Stable/di [Diagnosis] | Angina, Stable/pp [Physiopathology] | Angina, Unstable/di [Diagnosis] | Angina, Unstable/pp [Physiopathology] | Coronary Angiography | Coronary Restenosis/di [Diagnosis] | Coronary Restenosis/ep [Epidemiology] | District of Columbia/ep [Epidemiology] | Female | Follow-Up Studies | Humans | Male | Middle Aged | Myocardial Infarction/di [Diagnosis] | Myocardial Infarction/pp [Physiopathology] | Postoperative Period | Prevalence | Prognosis | Registries | Retrospective Studies | Risk Factors | Time FactorsLocal holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: Percutaneous coronary intervention in the setting of acute myocardial infarction is known to predict stent thrombosis (ST). This study aims to compare the ST rates across different coronary subsets. This was an observational cohort study from a large, single-center registry. Included were 12,198 consecutive patients who underwent percutaneous coronary intervention with stenting. Patients were categorized according to their clinical presentation: stable angina pectoris (SAP, n = 3,700), unstable angina pectoris (UAP, n = 2,845), non-ST-segment elevation myocardial infarction (NSTEMI, n = 4,083), and ST-segment elevation myocardial infarction (STEMI, n = 1,570). The study end points were ST rates at 1 year. Patients with STEMI were younger with a lower prevalence of cardiovascular risk factors, except for smoking. More type C lesions were treated in STEMI, whereas drug-eluting stents were used less frequently in patients with STEMI compared with the other groups. Definite ST at 1 year was highest in patients with STEMI (1.4%; vs SAP, 0.4%; UAP, 0.5%; NSTEMI, 0.5%; p <0.001). One-year definite/probable ST rates were SAP, 0.8%; UAP, 1.1%; NSTEMI, 1.4%; and STEMI, 3.2% (p <0.001). On multivariable analysis, STEMI independently predicts definite ST (hazards ratio [HR] 3.07, 95% confidence interval [CI] 1.32 to 7.10), whereas both STEMI (HR 3.36, 95% CI 1.84 to 6.12) and NSTEMI (HR 2.04, 95% CI 1.20 to 3.07) were independent predictors of definite/probable ST. Clopidogrel cessation was the strongest predictor of ST (definite ST, HR 17.00, 95% CI 7.54 to 38.31; definite/probable ST, HR 4.69, 95% CI 2.39 to 9.20). In conclusion, in patients who underwent percutaneous coronary intervention, the acuity of clinical presentation corresponds to an increase in ST incidence. Adherence to clopidogrel is critical to prevent ST in patients who underwent percutaneous coronary intervention, especially in STEMI. Copyright 2014 Elsevier Inc. All rights reserved.All authors: Chen F, Kitabata H, Loh JP, Minha S, Omar A, Pendyala LK, Pichard AD, Satler LF, Torguson R, Waksman RDigital Object Identifier: Date added to catalog: 2014-08-21
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Journal Article MedStar Authors Catalog Article Available 24837256

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Percutaneous coronary intervention in the setting of acute myocardial infarction is known to predict stent thrombosis (ST). This study aims to compare the ST rates across different coronary subsets. This was an observational cohort study from a large, single-center registry. Included were 12,198 consecutive patients who underwent percutaneous coronary intervention with stenting. Patients were categorized according to their clinical presentation: stable angina pectoris (SAP, n = 3,700), unstable angina pectoris (UAP, n = 2,845), non-ST-segment elevation myocardial infarction (NSTEMI, n = 4,083), and ST-segment elevation myocardial infarction (STEMI, n = 1,570). The study end points were ST rates at 1 year. Patients with STEMI were younger with a lower prevalence of cardiovascular risk factors, except for smoking. More type C lesions were treated in STEMI, whereas drug-eluting stents were used less frequently in patients with STEMI compared with the other groups. Definite ST at 1 year was highest in patients with STEMI (1.4%; vs SAP, 0.4%; UAP, 0.5%; NSTEMI, 0.5%; p <0.001). One-year definite/probable ST rates were SAP, 0.8%; UAP, 1.1%; NSTEMI, 1.4%; and STEMI, 3.2% (p <0.001). On multivariable analysis, STEMI independently predicts definite ST (hazards ratio [HR] 3.07, 95% confidence interval [CI] 1.32 to 7.10), whereas both STEMI (HR 3.36, 95% CI 1.84 to 6.12) and NSTEMI (HR 2.04, 95% CI 1.20 to 3.07) were independent predictors of definite/probable ST. Clopidogrel cessation was the strongest predictor of ST (definite ST, HR 17.00, 95% CI 7.54 to 38.31; definite/probable ST, HR 4.69, 95% CI 2.39 to 9.20). In conclusion, in patients who underwent percutaneous coronary intervention, the acuity of clinical presentation corresponds to an increase in ST incidence. Adherence to clopidogrel is critical to prevent ST in patients who underwent percutaneous coronary intervention, especially in STEMI. Copyright 2014 Elsevier Inc. All rights reserved.

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