AUTHOR=Chi Gerald , AlKhalfan Fahad , Lee Jane J. , Montazerin Sahar Memar , Fitzgerald Clara , Korjian Serge , Omar Wally , Barnathan Elliot , Plotnikov Alexei , Gibson C. Michael 

TITLE=Factors associated with early, late, and very late stent thrombosis among patients with acute coronary syndrome undergoing coronary stent placement: analysis from the ATLAS ACS 2-TIMI 51 trial

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1269011

DOI=10.3389/fcvm.2023.1269011

ISSN=2297-055X

ABSTRACT=Background: Stent thrombosis (ST) is an uncommon but serious complication of stent implantation. This study aimed to explore factors associated with early, late, and very late ST to help guide risk assessment and clinical decision-making of ST.The analysis included patients who received stent placement for the index acute coronary syndrome (ACS). Cumulative incidence of ST was assessed at 30 days (early ST), 31 to 360 days (late ST), 361 to 720 days (very late ST), and up to 720 days. Cox proportional-hazards models were used to assess associations between ST and various factors, including patient characteristics (i.e., age, sex, ACS presentation, history of hypertension, smoking, diabetes, prior myocardial infarction (MI), heart failure, prior ischemic stroke, and cancer), laboratory tests (i.e., positive cardiac biomarker, hemoglobin, platelet count, white blood cell [WBC] count), and treatment (i.e., drug-eluting stent [DES] vs. bare-metal stent [BMS] and anticoagulant with rivaroxaban vs. placebo).Results: Among 8,741 stented patients, 155 ST events (2.25%) occurred by day 720. The cumulative incidence of early, late, and very late ST was 0.80%, 0.81%, and 0.77%, respectively. After multivariable adjustment, age ≥ 75 (HR=2.13 [95% CI: 1.26-3.60]), a history of prior MI (HR=1.81 [95% CI: 1.22-2.68]), low hemoglobin level (HR=2.34 [95% CI: 1.59-3.44]), and high WBC count (HR=1.58 [95% CI: 1.02-2.46]) were associated with a greater risk of overall ST, whereas DES (HR=0.56 [95% CI: 0.38-0.83]) and rivaroxaban therapy (HR=0.63 [95% CI: 0.44-0.88]) were associated with a lower risk of overall ST up to 720 days. Low hemoglobin level and high WBC count were associated with early ST (low hemoglobin: HR=2.35 [95% CI: 1.34-4.12]; high WBC count: HR=2.11 [95% CI: 1.17-3.81]). Low hemoglobin level and prior MI were associated with a greater risk of late ST (low hemoglobin: HR=2.32 [95% CI: 1.26-4.27]; prior 3 MI: HR=2.98 [95% CI: 1.67-5.31]), whereas DES was associated with a lower risk of late ST (HR=0.33 [95% CI: 0.16-0.67]). Age ≥ 75 was associated with very late ST.The study identified positive and negative associations with early, late, and, very late ST. These variables may be useful in constructing risk assessment models for ST.