RSS-Feed abonnieren
DOI: 10.1160/TH05-12-0802
Incidence and predictors of subacute thrombosis in patients undergoing primary angioplasty for an acute myocardial infarction
Publikationsverlauf
Received
15. Dezember 2005
Accepted after minor revision
14. Juni 2006
Publikationsdatum:
28. November 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/200602/lookinside/thumbnails/10-1160-th05-12-0802-1.jpg)
Summary
Subacute thrombosis (SAT) is a major concern in patients undergoing percutaneous coronary intervention (PCI). So far, only little data has been available on characteristics and outcome of patients with SAT after primary PCI for ST elevation myocardial infarction (STEMI). From 1997–2001, 1,548 unselected consecutive patients underwent primary PCI for STEMI as part ofa randomized controlled trial stenting vs. balloon angioplasty. All patients received acetylsalicylic acid (500 mg i. v.) and heparin (5,000 IU) before the procedure. After stenting, all patients received ticlopidine 250 mg daily (before July 1999) or clopidogrel 75 mg daily (after July 1999) for one month. Five percent of patients received glycoprotein IIb/IIIa blockers. We prospectively recorded incidence and characteristics of patients with SAT during one year follow-up. SAT occurred in 4. 1% (63/1548) and reinfarction in 6. 0% of patients. The incidence of SAT did not change over time (1997: 8/175[4. 6%],1998: 8/325 [2.5%],1999: 13/358 [3.6%], 2000: 22/426 [5.2%], 2001: 12/264 [4.5%]). SAT occurred in 39/63(62%) patients during hospital stay. The incidence did not differ between patients after ticlopidine 23/681 (3.4%) or clopidogrel 40/867 (4. 6%, p=0. 222). Univariate predictors of SAT were: patients with an LAD stenosis (5.4% vs. 2.9%, p=0. 016), with Killip class>1 at presentation (8.6% vs. 3.7%, p=0.007) and in patients who received a stent (5.1% vs. 2.7%, p=0. 022). After multivariate analysis, Killip class>1 on admission was the only independent predictor of SAT(OR 2.26, 95% CI 1.14–4.47, p=0.019). SAT was associated with a higher mortality at long-term follow-up (15% vs. 7%, p=0. 026). In a prospectively recorded, unselected consecutive series of patients undergoing PCI for STEMI, SAT occurred in 4. 1% of patients at oneyear follow-up. Signs of heart failure on admission, anterior myocardial infarction and stenting were predictors of SAT.
-
References
- 1 Zijlstra F, Hoorntje JCA, de Boer MJ. et al. Longterm benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1999; 341: 1413-19.
- 2 Boersma E, Maas AC, Deckers JW. et al. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet 1996; 348: 771-5.
- 3 Fischman DL, Leon MB, Baim DS. et al. for the stent restenosis study investigators. A randomised comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994; 331: 496-501.
- 4 Gibson CM, Karha J, Murphy SA. et al. for the TIMI study group. Early and long-term clinical outcomes associated with reinfarction following fibrinolytic administration in the thrombolysis in myocardial infarction trials. J Am Coll Cardiol 2003; 42: 7-16.
- 5 Kernis SJ, Harjai KJ, Stone GW. et al. The incidence, predictors, and outcomes of early reinfarction after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 2003; 42: 1173-7.
- 6 Haude M, Erbel R, Issa H. et al. Subacute thrombotic complications after intracoronary implantation of Palmaz-Schatz stents. Am HeartJ 1993; 126: 15-22.
- 7 Malenka DJ, O’Rourke D, Miller MA. et al. Cause of in-hospital death in 12,232 consecutive patients undergoing percutaneous transluminal coronary angioplasty. The Northern New England Cardiovascular Disease Study Group. Am HeartJ 1999; 137: 582-4.
- 8 Hudson MP, Granger CB, Topol EJ. et al. Early reinfarction after fibrinolysis: experience from the global utilisation of streptokinase and tissue plasminogen activator (alteplase) for occluded coronary arteries (GUSTO I) and global use of strategies to open occluded coronary arteries (GUSTO III) trials. Circulation 2001; 104: 1229-35.
- 9 Marmor A, Sobel BE, Roberts R. Factors presaging early recurrent myocardial infarction (“extension”). Am J Cardiol 1981; 48: 603-10.
- 10 Donges K, Schiele R, Gitt A. et al. Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and Myocardial Infarction Registry (MIR) Study Groups. Incidence, determinants, and clinical course of reinfarction in-hospital after index acute myocardial infarction (results from the pooled data of the maximal individual therapy in acute myocardial infarction [MITRA], and the myocardial infarction registry [MIR]). Am J Cardiol 2001; 87: 1039-44.
- 11 Kornowski R, Goldbourt U, Zion M. et al. Predictors and long-term prognostic significance of recurrent infarction in the year after afirst myocardial infarction. SPRINT Study Group. Am J Cardiol 1993; 72: 883-8.
- 12 Moussa I, Mario CD, Reimers B. et al. Subacute stent thrombosis in the era of intravascular ultrasoundguided coronary stenting without anticoagulation: frequency, predictors and clinical outcome. J Am Coll Cardiol 1997; 29: 6-12.
- 13 Cutlip DE, Baim DS, Ho KK. et al. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001; 103: 1967-71.
- 14 Cheneau E, Leborgne L, Mintz GS. et al. Predictors of subacute stent thrombosis. Results of a systematic intravascular ultrasound study. Circulation 2003; 108: 43-7.
- 15 Suryapranata H, De Luca G, van ’t Hof AWJ. et al. Is routine stenting for acute myocardial infarction superior to balloon angioplasty? A randomised comparison in a large cohort of unselected patients. Heart 2005; 91: 641-5.
- 16 Suryapranata H, van ’t Hof AWJ, Hoorntje JCA. et al. Randomised comparison of coronary stenting with balloon angioplasty in selected patients with acute myocardial infarction. Circulation 1998; 97: 2502-5.
- 17 Chesebro JH, Knatterud G, Roberts R. et al. Thrombolysis In Myocardial Infarction (TIMI) trial, phase 1: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Circulation 1987; 76: 142-54.
- 18 Gibson CM, Cannon CP, Daley WL. et al. TIMI frame count:a quantitative method of assessing coronary artery flow. Circulation 1996; 93: 879-88.
- 19 van ’t Hof AWJ, Liem A, Suryapranata H. et al. on behalf of the Zwolle myocardial infarction study group. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Circulation 1998; 97: 2302-6.
- 20 Zijlstra F, de Boer MJ, Hoorntje JCA. et al. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N EnglJ Med 1993; 328: 680-4.
- 21 Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003; 361: 13-20.
- 22 Volpi A, de Vita C, Franzosi MG. et al. Predictors of nonfatal reinfarction in survivors of myocardial infarction after thrombolysis. Results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI-2) Data Base. J Am Coll Cardiol 1994; 24: 608-15.
- 23 Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico. GISSI-2: a factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with an acute myocardial infarction. Lancet 1990; 336: 65-71.
- 24 Henriques JPS, Zijlstra F, Ottervanger JP. et al. Incidence and clinical significance of distal embolisation during primary angioplasty for acute myocardial infarction. Eur HeartJ 2002; 23: 1076-8.
- 25 Mahdi NA, Lopez J, Leon M. et al. Comparison of primary coronary stenting to primary balloon angioplasty with stent bailout for the treatment of patients with acute myocardial infarction. Am J Cardiol 1998; 81: 957-63.
- 26 Stone GW, Brodie BR, Griffin JJ. et al. Prospective, multicenter study of the safety and feasibility of primary stenting in acute myocardial infarction: in-hospital and 30-day results of the PAMI stent pilot trial. Primary Angioplasty in Myocardial Infarction Stent Pilot Trial Investigators. J Am Coll Cardiol 1998; 31: 23-30.
- 27 Serruys PW, van Hout B, Bonnier H. et al. Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II). Lancet 1998; 352: 673-81.
- 28 Lansky AJ, Costa RA, Mintz GS. et al. DELIVER Clinical Trial Investigators. Non-polymer-based paclitaxel-coated coronary stents for the treatment of patients with de novo coronary lesions: angiographic follow-up of the DELIVER clinical trial. Circulation 2004; 109: 1948-54.
- 29 Moses JW, Leon MB, Popma JJ. et al. SIRIUS Investigators. Sirolimus-eluting stents versus standard stents in patients with stenosis ina native coronary artery. N EnglJ Med 2003; 349: 1315-23.
- 30 Stone GW, Grines CL, Cox DA. et al. Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Investigators. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med 2002; 346: 957-66.
- 31 Sheth S, Litvack F, Dev V. et al. Subacute thrombosis and vascular injury resulting from slotted-tube nitinol and stainless steel stents in a rabbit carotid artery model. Circulation 1996; 94 (01) 733-40.
- 32 Smit JJJ, Ernst NM, Slingerland RJ. et al. on behalf of the On-TIME study group. Platelet micro-aggregation inhibition in patients with an acute myocardial infarction pre-treated with tirofiban and relationship with angiographic and clinical outcome. Am Heart J 2006; 151: 1102-7.
- 33 Peterson ED, Pollack Jr. CV, Roe MT. et al. National Registry of Myocardial Infarction (NRMI) 4 Investigators. Early use of glycoprotein IIb/IIIa inhibitors in non-ST elevation myocardial infarction: observations from the National Registry of Myocardial Infarction 4. J Am Coll Cardiol 2003; 42: 54-6.
- 34 Moussa I, Oetgen M, Roubin G. et al. Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. Circulation 1999; 99: 2364-6.
- 35 Bertrand ME, Rupprecht HJ, Urban P. et al. Investigators FT. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: the clopidogrel aspirin stent international co-operative study (CLASSICS). Circulation 2000; 102: 624-9.
- 36 Bhatt DL, Bertrand ME, Berger PB. et al. Metaanalysis of randomised and registry comparisons of ticlopidine with clopidogrel after stenting. J Am Coll Cardiol 2002; 39: 9-14.
- 37 McFadden EP, Stabile E, Regar E. et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 2004; 364: 1519-21.
- 38 Cohen MG, Ohman EM. Drug-eluting stents in acute myocardial infarction: is science catching up with practice?. J Am Med Assoc 2005; 293: 2154-6.
- 39 Lemos PA, Saia F, Hofma SH. et al. Short- and long-term clinical benefit of sirolimus-eluting stents compared to conventional bare stents for patients with acute myocardial infarction. J Am Coll Cardiol 2004; 43: 704-8.