scholarly journals Clinical outcomes after percutaneous coronary intervention for early versus late and very late stent thrombosis: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Yi-Xing Yang ◽  
Yin Liu ◽  
Xiao-Wei Li ◽  
Peng-Ju Lu ◽  
Jiao Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Stent Thrombosis ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Percutaneous Coronary

scholarly journals Everolimus-Eluting versus Paclitaxel-Eluting Stents in Percutaneous Coronary Intervention: Meta-Analysis of Randomized Trials

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Ashraf Alazzoni ◽  
Ayman Al-Saleh ◽  
Sanjit S. Jolly
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Target Vessel Revascularization ◽  
Percutaneous Coronary

Background. Individual randomized trials have suggested that everolimus-eluting stents may have improved clinical outcomes compared to paclitaxel-eluting stents, but individual trials are underpowered to examine outcomes such as mortality and very late stent thrombosis. Methods. Medline, Cochrane, and conference proceedings were searched for randomized trials comparing everolimus versus paclitaxel-eluting stents for percutaneous coronary intervention. Results. 6792 patients were included from 4 randomized controlled trials. Stent thrombosis was reduced with everolimus stents versus paclitaxel stents (0.7% versus 2.3%; OR: 0.32; CI: 0.20–0.51; P<0.00001). The reductions in stent thrombosis were observed in (i) early stent thrombosis (within 30 days) (0.2% versus 0.9%; OR: 0.24; P=0.0005), (ii) late (day 31–365) (0.2% versus 0.6%; OR: 0.32; P=0.01), and (iii) very late stent thrombosis (>365 days) (0.2% versus 0.8%; OR: 0.34; P=0.009). The rates of cardiovascular mortality were 1.2% in everolimus group and 1.6% in paclitaxel group (OR: 0.85; P=0.43). Patients receiving everolimus-eluting stents had significantly lower myocardial infarction events and target vessel revascularization as compared to paclitaxel-eluting stents. Interpretation. Everolimus compared to paclitaxel-eluting stents reduced the incidence of early, late, and very late stent thrombosis as well as target vessel revascularization.

P960Association of peri-procedural intravenous morphine use on clinical outcomes in ST-elevation myocardial infarction treated by percutaneous coronary intervention: systematic review and meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Batchelor ◽  
D Liu ◽  
J Bloom ◽  
S Noaman ◽  
W Chan
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background Morphine analgesia may affect absorption of co-prescribed P2Y12 antagonists attenuating platelet inhibition. The impact of peri-procedural intravenous (IV) morphine administration on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is not well defined. Purpose To conduct a systematic review and meta-analysis exploring clinical outcomes with peri-procedural IV morphine in patients undergoing PPCI for STEMI. Methods Analysis of the electronic databases MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science and ClinicalTrials.gov for association of peri-PCI IV morphine use with myocardial infarction (MI) and mortality. Primary and secondary outcomes were in-hospital or 30-day MI and all-cause mortality respectively. Results Eleven studies (1 randomised controlled trial; 10 cohort studies) were included for systematic review. Five studies, including 3,748 patients were included in meta-analysis of the primary outcome. Of 3,748 patients, 2,239 were treated concurrently with ticagrelor, 1,256 treated with clopidogrel and 253 with prasugrel. As shown in the Figure, there was a trend towards increased risk of myocardial infarction with IV morphine (odds ratio 1.88; 95% CI 0.87–4.09, I2 0%). Across seven studies and 6585 patients, no increased risk of mortality at the same composite time endpoint was evident (odds ratio 0.70, 95% CI 0.40–1.23, I2 19%). Figure 1. MI in hospital or at 30 days Conclusion Based on current literature, evidence of an association between IV morphine and myocardial infarction in patients undergoing PPCI for STEMI is limited by observational methodology and conflicting results. There is no evidence of an association between intravenous peri-procedural morphine and mortality. Clinical trial evidence with strong documentation of adverse events data is required to demonstrate association or causality. Acknowledgement/Funding None

scholarly journals Very late stent thrombosis of bare-metal coronary stent nine years after primary percutaneous coronary intervention

2016 ◽  
Vol 73 (8) ◽  
pp. 774-778 ◽  
Author(s):  
Predrag Djuric ◽  
Slobodan Obradovic ◽  
Zoran Stajic ◽  
Marijan Spasic ◽  
Radomir Matunovic ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Antithrombotic Therapy ◽  
Coronary Intervention ◽  
Stent Fracture ◽  
Bare Metal ◽  
Thrombus Aspiration ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Percutaneous Coronary

Introduction. Stent thrombosis (ST) in clinical practice can be classified according to time of onset as early (0?30 days after stent implantation), which is further divided into acute (< 24 hours) and subacute (1?30 days), late (> 30 days) and very late (> 12 months). Myocardial reinfaction due to very late ST in a patient receiving antithrombotic therapy is very rare, and potentially fatal. The procedure alone and related mechanical factors seem to be associated with acute/subacute ST. On the other hand, in-stent neoathero-sclerosis, inflammation, premature cessation of antiplatelet therapy, as well as stent fracture, stent malapposition, un-covered stent struts may play role in late/very late ST. Some findings implicate that the etiology of very late ST of bare-metal stent (BMS) is quite different from those following drug-eluting stent (DES) implantation. Case report. We presented a 56-year old male with acute inferoposterior ST segment elevation myocardial infarction (STEMI) related to very late stent thrombosis, 9 years after BMS implantation, despite antithrombotic therapy. Thrombus aspiration was successfully performed followed by percutaneous coronary intervention (PCI) with implantation of DES into the pre-viously implanted two stents to solve the in-stent restenosis. Conclusion. Very late stent thrombosis, although fortu-nately very rare, not completely understood, might cause myocardial reinfaction, but could be successfully treated with thrombus aspiration followed by primary PCI. Very late ST in the presented patient might be connected with neointimal plaque rupture, followed by thrombotic events.

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