Impact of inhospital stent thrombosis and cerebrovascular accidents on long-term prognosis after percutaneous coronary intervention

• Published in: The American heart journal 2014-12, Vol.168 (6), p.862-868.e1
• Main Authors: Guerra, Elena, MD, Ndrepepa, Gjin, MD, Schulz, Stefanie, MD, Byrne, Robert, MD, Hoppmann, Petra, MD, Kufner, Sebastian, MD, Ibrahim, Tareq, MD, Tada, Tomohisa, MD, Schunkert, Heribert, MD, Laugwitz, Karl-Ludwig, MD, Kastrati, Adnan, MD
• Format: Article
• Language: English
• Subjects: Aged; Cardiology; Cardiovascular; Coronary Angiography - methods; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Coronary vessels; Drug-Eluting Stents - adverse effects; Female; Germany - epidemiology; Graft Occlusion, Vascular - diagnosis; Graft Occlusion, Vascular - epidemiology; Graft Occlusion, Vascular - mortality; Heart attacks; Hospitalization; Hospitalization - statistics & numerical data; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Percutaneous Coronary Intervention - statistics & numerical data; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Stroke - epidemiology; Stroke - etiology; Studies; Thrombosis - diagnosis; Thrombosis - epidemiology; Thrombosis - etiology; Thrombosis - mortality; Time Factors; Treatment Outcome
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2014.08.015

Background Inhospital stent thrombosis (ST) and cerebrovascular accidents (CVA) are rare but serious adverse events after percutaneous coronary intervention (PCI). The association of ST or CVA with long-term outcome after PCI remains poorly investigated. Methods The study included 18,334 consecutive patients who underwent PCI. Patients were divided into 3 groups: the group with ST, the group with CVA, and the group without these events. The primary outcome was all-cause mortality at 3-year follow-up. Results Inhospital ST or CVA occurred in 59 patients (0.32%) and in 90 patients (0. 49%), respectively. There were 2,149 deaths (11.7%) during the follow-up: 26 deaths among patients with ST, 32 deaths among patients with CVA, and 2,091 deaths among patients without ST or CVA (Kaplan-Meier estimates of 3-year mortality 45.3%, 38.0%, and 12.9%, odds ratio 6.1, 95% CI 3.6-10.2, P < .001 for ST group vs the group without ST or CVA and odds ratio 4.2 [2.7-6.6], P < .001 for CVA group vs the group without ST or CVA). There was no significant difference in the 3-year mortality between CVA and ST groups ( P = .29). The Cox proportional hazards model showed that ST (adjusted hazard ratio 4.97, 95% CI 2.58-9.56, P < .001) and CVA (adjusted hazard ratio 2.25 [1.25-4.04], P = .006) were independently associated with the increased risk of 3-year mortality. Conclusion Inhospital ST and CVA after PCI are associated with the increased risk of 3-year mortality. Both events seem to have a similar impact on long-term survival.