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Causes of Early Stent Thrombosis in Patients Presenting with Acute Coronary Syndrome: An Ex Vivo Human Autopsy Study.
MedLine Citation:
PMID:  24768883     Owner:  NLM     Status:  Publisher    
OBJECTIVE: We interrogated our autopsy registry to investigate the histopathologic features of early stent thrombosis (ST) in patients presenting with acute coronary syndrome (ACS).
BACKGROUND: The occurrence of early ST following percutaneous coronary intervention (PCI) for ACS remains a clinical problem despite advances in stent technology in both bare metal and drug-eluting stents.
METHODS: - Sixty-seven stented coronary lesions from 59 patients who presented with ACS and died within 30 days were included. Stented segments were cross-sectioned at 3-4 mm intervals, evaluated by light microscopy, and morphometric analysis was performed.
RESULTS: Early ST (<30 days of PCI) was identified in 34 (58%) of the 59 patients. Early ST was dependent on the underlying plaque morphology and underlying thrombus burden: presence of necrotic core prolapse was more frequent in thrombosed lesions compared with patent lesions (70% vs. 43%, p=0.045) and maximum underlying thrombus thickness was significantly greater in thrombosed versus patent lesions. All 3 patients with false lumen stenting had ST. Detailed analysis revealed that the percentage of necrotic core prolapse, medial tear, or incomplete apposition was significantly greater in the early ST compared with patent group (28% vs.11%, p<0.001, 27% vs. 15% p=0.004, and 34% vs. 18% p =0.008, respectively). Multivariate analysis revealed that maximum depth of strut penetration, % strut with medial tear, and % struts with incomplete apposition were the primary indicators of early ST.
CONCLUSIONS: - The current autopsy study highlights the impact of thrombus burden and suboptimal stent implantation in unstable lesions as a trigger of early ST, suggesting that improvement in implantation technique and refinement of stent design may improve clinical outcomes of ACS patients.
Masataka Nakano; Kazuyuki Yahagi; Fumiyuki Otsuka; Kenichi Sakakura; Aloke V Finn; Robert Kutys; Elena Ladich; David R Fowler; Michael Joner; Renu Virmani
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-12
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  -     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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