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Background <p>Stent thrombosis (ST) remains a serious complication after percutaneous coronary intervention, leading to acute myocardial infarction (AMI) in over 70% of cases. And it has been reported that the prognosis for ST is worse than for de-novo AMI. While the use of second-generation drug-eluting stents (G2-DES) has reduced ST incidence, ST remains a concern, and its incidence and prognosis in the G2-DES era have not been well studied.</p> Aims <p>To evaluate the incidence and prognosis of AMI due to ST in the G2-DES era compared with de-novo AMI.</p> Methods <p>From January 2013 to November 2022, we analyzed 6273 consecutive AMI patients from the Mie ACS Registry, including 78 ST and 6195 de-novo type 1 AMI (de-novo AMI) after exclusion of the other type of AMI. The primary endpoint was all-cause mortality, and target lesion revascularization (TLR) was the secondary endpoint.</p> Results <p>ST occurred in 1.2% (n = 78) of AMI, predominantly as very late ST (79.5%, n = 62). Thirty-day mortality was marginally lower in ST (2.6%) than de-novo AMI (6.7%, p = 0.16), with ST not being an independent predictor of 30-day mortality (HR 0.39, p = 0.19). However, ST patients had a higher 2-year TLR rate (21.4% vs. 11.9%, p = 0.02), confirmed as an independent predictor (HR 2.03, p = 0.01). Compared to previous clinical data, the reduced incidence of ST and the improved prognosis was observed.</p> Conclusions <p>While ST-related AMI prognosis has improved, with mortality comparable to de-novo AMI, the higher TLR rate in ST patients persists, and an optimized revascularization strategy is still needed.</p> Graphical Abstract <p>Changes in clinical findings and prognosis of stent thrombosis in AMI over time. (Comparison with previous clinical trials) [<CitationRef CitationID="CR13">13</CitationRef>, <CitationRef CitationID="CR17">17</CitationRef>, <CitationRef CitationID="CR18">18</CitationRef>]. <b>A</b> Transition of stent types over time. <b>B</b> Incidence of stent thrombosis in STEMI. <b>C</b> Type of stent thrombosis in STEMI. D Prognosis of stent thrombosis in STEMI. <b>E</b> Kaplan–Meier survival curve for revascularization after PCI for AMI. <b>F</b> Multivariate cox regression analysis for predicting revascularization after PCI for AMI. <i>AMI</i>; acute myocardial infarction, <i>BMS</i>; bare metal stent, <i>EST</i>; early stent thrombosis, <i>G1-DES</i>; first-generation drug eluting stent, <i>G2-DES</i>; second-generation drug eluting stent, <i>LAD</i>; left anterior descending artery, <i>LST</i>; late stent thrombosis, <i>PCI</i>; percutaneous coronary intervention, <i>RCA</i>; right coronary artery, <i>ST</i>; stent thrombosis, <i>STEMI</i>; ST elevation myocardial infarction, <i>VLST</i>; very late stent thrombosis</p> <p></p>

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Stent thrombosis in acute myocardial infarction in the era of second-generation drug-eluting stent: incidence, prognosis, and historical comparisons with previous stent era

  • 期刊论文

  • 发表日期：

    2025年8月30日

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  • Yosuke Kirii,
  • Tairo Kurita,
  • Hiroki Kainuma,
  • Kazuma Yamaguchi,
  • Hiroki Mori,
  • Masashi Yanagisawa,
  • Takahiro Okazaki,
  • Akiyoshi Ikami,
  • Tomoyuki Fukuma,
  • Hiromasa Ito,
  • Takashi Kato,
  • Masaki Ishiyama,
  • Akihiro Takasaki,
  • Yuichi Sato,
  • Takeshi Takamura,
  • Kaoru Dohi

摘要

Background

Stent thrombosis (ST) remains a serious complication after percutaneous coronary intervention, leading to acute myocardial infarction (AMI) in over 70% of cases. And it has been reported that the prognosis for ST is worse than for de-novo AMI. While the use of second-generation drug-eluting stents (G2-DES) has reduced ST incidence, ST remains a concern, and its incidence and prognosis in the G2-DES era have not been well studied.

Aims

To evaluate the incidence and prognosis of AMI due to ST in the G2-DES era compared with de-novo AMI.

Methods

From January 2013 to November 2022, we analyzed 6273 consecutive AMI patients from the Mie ACS Registry, including 78 ST and 6195 de-novo type 1 AMI (de-novo AMI) after exclusion of the other type of AMI. The primary endpoint was all-cause mortality, and target lesion revascularization (TLR) was the secondary endpoint.

Results

ST occurred in 1.2% (n = 78) of AMI, predominantly as very late ST (79.5%, n = 62). Thirty-day mortality was marginally lower in ST (2.6%) than de-novo AMI (6.7%, p = 0.16), with ST not being an independent predictor of 30-day mortality (HR 0.39, p = 0.19). However, ST patients had a higher 2-year TLR rate (21.4% vs. 11.9%, p = 0.02), confirmed as an independent predictor (HR 2.03, p = 0.01). Compared to previous clinical data, the reduced incidence of ST and the improved prognosis was observed.

Conclusions

While ST-related AMI prognosis has improved, with mortality comparable to de-novo AMI, the higher TLR rate in ST patients persists, and an optimized revascularization strategy is still needed.

Graphical Abstract

Changes in clinical findings and prognosis of stent thrombosis in AMI over time. (Comparison with previous clinical trials) [13, 17, 18]. A Transition of stent types over time. B Incidence of stent thrombosis in STEMI. C Type of stent thrombosis in STEMI. D Prognosis of stent thrombosis in STEMI. E Kaplan–Meier survival curve for revascularization after PCI for AMI. F Multivariate cox regression analysis for predicting revascularization after PCI for AMI. AMI; acute myocardial infarction, BMS; bare metal stent, EST; early stent thrombosis, G1-DES; first-generation drug eluting stent, G2-DES; second-generation drug eluting stent, LAD; left anterior descending artery, LST; late stent thrombosis, PCI; percutaneous coronary intervention, RCA; right coronary artery, ST; stent thrombosis, STEMI; ST elevation myocardial infarction, VLST; very late stent thrombosis