The incidence and clinical predictors of early stent thrombosis in patients with acute coronary syndrome

Abstract Background Prasugrel and ticagrelor are both effective anti-platelet drugs for patients with acute coronary syndrome. However, there has been limited data on the direct comparison of prasugrel and ticagrelor until the recent ISAR-REACT 5 trial. Purpose To compare the efficacy of prasugrel and ticagrelor in patients with acute coronary syndrome with respect to the primary composite endpoint of myocardial infarction (MI), stroke or cardiac cardiovascular death, and secondary endpoints including MI, stroke, cardiovascular death, major bleeding (Bleeding Academic Research Consortium (BARC) type 2 or above), and stent thrombosis within 1 year. Methods Meta-analysis was performed on randomised controlled trials (RCT) up to December 2019 that randomised patients with acute coronary syndrome to either prasugrel or ticagrelor. RCTs were identified from Medline, Embase and ClinicalTrials.gov using Cochrane library CENTRAL by 2 independent reviewers with “prasugrel” and “ticagrelor” as search terms. Effect estimates with confidence intervals were generated using the random effects model by extracting outcome data from the RCTs to compare the primary and secondary clinical outcomes. Cochrane risk-of-bias tool for randomised trials (Ver 2.0) was used for assessment of all eligible RCTs. Results 411 reports were screened, and we identified 11 eligible RCTs with 6098 patients randomised to prasugrel (n=3050) or ticagrelor (n=3048). The included trials had a follow up period ranging from 1 day to 1 year. 330 events on the prasugrel arm and 408 events on the ticagrelor arm were recorded. There were some concerns over the integrity of allocation concealment over 7 trials otherwise risk of other bias was minimal. Patients had a mean age of 61±4 (76% male; 50% with ST elevation MI; 35% with non-ST elevation MI; 15% with unstable angina; 25% with diabetes mellitus; 64% with hypertension; 51% with hyperlipidaemia; 42% smokers). There was no significant difference in risk between the prasugrel group and the ticagrelor group on the primary composite endpoint (Figure 1) (Risk Ratio (RR)=1.17; 95% CI=0.97–1.41; p=0.10, I2=0%). There was no significant difference between the use of prasugrel and ticagrelor with respect to MI (RR=1.24; 95% CI=0.81–1.90; p=0.31); stroke (RR=1.05; 95% CI=0.66–1.67; p=0.84); cardiovascular death (RR=1.01; 95% CI=0.75–1.36; p=0.95); BARC type 2 or above bleeding (RR=1.17; 95% CI =0.90–1.54; p=0.24); stent thrombosis (RR=1.58; 95% CI =0.90–2.76; p=0.11). Conclusion Compared with ticagrelor, prasugrel did not reduce the primary composite endpoint of MI, stroke and cardiovascular death within 1 year. There was also no significant difference in the risk of MI, stroke, cardiovascular death, major bleeding and stent thrombosis respectively. Figure 1. Primary Objective Funding Acknowledgement Type of funding source: None

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Optical Frequency Domain Imaging to Reveal an Angiographically Inapparent Very Late Stent Thrombosis as the Cause of an Acute Coronary Syndrome

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2012.03.069 ◽

2012 ◽

Vol 60 (7) ◽

pp. e11

Author(s):

Milosz Jaroslaw Jaguszewski ◽

Silke Kuest ◽

Christian Templin ◽

Ulf Landmesser

Keyword(s):

Acute Coronary Syndrome ◽

Frequency Domain ◽

Stent Thrombosis ◽

Optical Frequency ◽

Late Stent Thrombosis ◽

Very Late Stent Thrombosis ◽

Optical Frequency Domain Imaging ◽

Coronary Syndrome

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Relationship between aspirin and clopidogrel responses in acute coronary syndrome and clinical predictors of non response

Thrombosis Research ◽

10.1016/j.thromres.2008.04.003 ◽

2009 ◽

Vol 123 (4) ◽

pp. 597-603 ◽

Cited By ~ 59

Author(s):

Thomas Cuisset ◽

Corinne Frere ◽

Jacques Quilici ◽

Pierre-Emmanuel Morange ◽

Laurence Camoin ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Predictors ◽

Coronary Syndrome

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Clinical Predictors of Culprit Plaque Rupture Assessed on Intravascular Ultrasound in Acute Coronary Syndrome

Circulation Journal ◽

10.1253/circj.cj-10-0086 ◽

2010 ◽

Vol 74 (9) ◽

pp. 1936-1942 ◽

Cited By ~ 15

Author(s):

Masaya Kato ◽

Keigo Dote ◽

Toru Naganuma ◽

Shota Sasaki ◽

Kentaro Ueda ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Intravascular Ultrasound ◽

Plaque Rupture ◽

Clinical Predictors ◽

Coronary Syndrome

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TCTAP A-008 Single Center Experience of Acute Coronary Syndrome Due to Stent Thrombosis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.03.034 ◽

2017 ◽

Vol 69 (16) ◽

pp. S4

Author(s):

Hirohide Matsuura ◽

Yuhei Goriki ◽

Tatsuya Nakama ◽

Yoshisato Shibata

Keyword(s):

Acute Coronary Syndrome ◽

Stent Thrombosis ◽

Single Center ◽

Coronary Syndrome ◽

Single Center Experience

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Abstract 12644: Growth Differentiation Factor-15 (GDF-15) for Risk Stratification in Patients After an Acute Coronary Syndrome: Insights From the SOLID-TIMI 52 trial

Circulation ◽

10.1161/circ.132.suppl_3.12644 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Eri Toda Kato ◽

David A Morrow ◽

Christopher P Cannon ◽

Mary Ann Lukas ◽

Andrzej Budaj ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Biomarkers ◽

Individual Element ◽

Clinical Predictors ◽

Coronary Syndrome ◽

Differentiation Factor ◽

Increased Risk ◽

Prognostic Utility ◽

Traditional Risk Factors ◽

Risk Predictors

Background: Growth differentiation factor (GDF)-15, a stress responsive cytokine, is associated with the risk of CV events after an acute coronary syndrome (ACS). Unlike other established cardiac biomarkers, the level of GDF-15 remains elevated in sub-acute phase after ACS and gradually decreases over time. We evaluated the prognostic utility of GDF-15 in patients after ACS accounting for established markers and risk predictors. Methods: GDF-15 (R&D Systems) and other established cardiac biomarkers (BNP, hsCRP and hsTnI) were measured at baseline in a randomly selected cohort of 4,968 patients enrolled within 30 days of hospitalization with ACS (median=14d) in SOLID-TIMI 52. Previously defined cutpoints were applied for GDF-15 concentration: <1200 (n=3451), 1200-1800 (n=919), and > 1800 ng/L (n=598). Analyses were adjusted for established risk predictors, days from the ACS event and other markers. MACE was defined as CV death, MI or stroke. Median follow-up was 2.5 years. Results: Patients with higher GDF-15 tended to be older, more likely to have diabetes, hypertension, history of revascularization, and CKD at baseline. Higher baseline levels of GDF-15 identified patients with higher rates of MACE as well as each individual element (p-trend <0.001 for all endpoints, Fig). The rate of MI was ∼2-fold higher in those with GDF-15 concentration >1800ng/L compared to patients with GDF-15 concentration <1200 ng/L. After adjustment for clinical predictors and other markers, GDF-15 was independently associated with the risk of MACE (HR 1.4, 95% CI 1.1-1.7; HR 1.8, 95% CI 1.4-2.3 for GDF-15 1200-1800, >1800, respectively). Individuals with GDF-15 >1800 ng/L had an increased risk of MI (adj HR 1.4, 95% CI 1.1-2.0) and stroke (adj HR 2.3, 95% CI 1.3-3.9). Conclusion: In patients after ACS, GDF-15 concentration is associated with the risk of MACE including MI and stroke independent of traditional risk factors and risk markers.

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DEMOGRAPHIC AND CLINICAL PREDICTORS OF ACUTE CORONARY SYNDROME IN PATIENTS WITH PREHOSPITAL CHEST PAIN AND BENIGN ECG FINDINGS

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2018.07.431 ◽

2018 ◽

Vol 34 (10) ◽

pp. S201-S202

Author(s):

S. Al-Zaiti ◽

Z. Faramand ◽

C. Martin-Gill ◽

C. Callaway

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Clinical Predictors ◽

Coronary Syndrome

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P4601Risk of myocardial infarction or stent thrombosis by total stent length in acute coronary syndrome patients undergoing percutaneous coronary intervention with second generation drug-eluting stents

European Heart Journal ◽

10.1093/eurheartj/ehy563.p4601 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

B Caneiro ◽

E Abu-Assi ◽

S Raposeiras-Roubin ◽

R J Cobas Paz ◽

I Munoz Pousa ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Stent Thrombosis ◽

Coronary Intervention ◽

Drug Eluting Stents ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Stent Length ◽

Drug Eluting

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Acute Coronary Syndrome after 17 Years of Bare Metal Stent Implantation: “Very” Very Late Stent Thrombosis

Case Reports in Cardiology ◽

10.1155/2020/9628719 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Raghavendra Rao K ◽

S. Reddy ◽

J. R. Kashyap ◽

K. Vikas ◽

Hithesh Reddy ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Stent Thrombosis ◽

Plaque Rupture ◽

Bare Metal Stents ◽

Metal Stents ◽

Bare Metal ◽

Late Stent Thrombosis ◽

Very Late Stent Thrombosis ◽

Mortality And Morbidity ◽

Coronary Syndrome

Very late stent thrombosis (VLST) is a catastrophic and life-threatening complication after percutaneous coronary intervention which presents as an acute coronary syndrome with significantly high mortality and morbidity. VLST is a rare entity with drug-eluting stents and even rarer with bare metal stents. The exact pathophysiologic mechanism of VLST after BMS implantation is not known although various mechanisms have been proposed. Recently, in-stent neoatherosclerosis with intimal plaque rupture has been proposed as a potential mechanism of VLST after BMS. We report a rare case of VLST occurring 17 years after BMS implantation with angiographic and intravascular imaging evidence which provides insight into the mechanisms of VLST.

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