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Comparison of outcomes after percutaneous coronary intervention among different coronary subsets (stable and unstable angina pectoris and ST-segment and non-ST-segment myocardial infarction).
Am J Cardiol. 2014 Jun 01; 113(11):1794-801.AJ

Abstract

Percutaneous coronary intervention in the setting of acute myocardial infarction is known to predict stent thrombosis (ST). This study aims to compare the ST rates across different coronary subsets. This was an observational cohort study from a large, single-center registry. Included were 12,198 consecutive patients who underwent percutaneous coronary intervention with stenting. Patients were categorized according to their clinical presentation: stable angina pectoris (SAP, n = 3,700), unstable angina pectoris (UAP, n = 2,845), non-ST-segment elevation myocardial infarction (NSTEMI, n = 4,083), and ST-segment elevation myocardial infarction (STEMI, n = 1,570). The study end points were ST rates at 1 year. Patients with STEMI were younger with a lower prevalence of cardiovascular risk factors, except for smoking. More type C lesions were treated in STEMI, whereas drug-eluting stents were used less frequently in patients with STEMI compared with the other groups. Definite ST at 1 year was highest in patients with STEMI (1.4%; vs SAP, 0.4%; UAP, 0.5%; NSTEMI, 0.5%; p <0.001). One-year definite/probable ST rates were SAP, 0.8%; UAP, 1.1%; NSTEMI, 1.4%; and STEMI, 3.2% (p <0.001). On multivariable analysis, STEMI independently predicts definite ST (hazards ratio [HR] 3.07, 95% confidence interval [CI] 1.32 to 7.10), whereas both STEMI (HR 3.36, 95% CI 1.84 to 6.12) and NSTEMI (HR 2.04, 95% CI 1.20 to 3.07) were independent predictors of definite/probable ST. Clopidogrel cessation was the strongest predictor of ST (definite ST, HR 17.00, 95% CI 7.54 to 38.31; definite/probable ST, HR 4.69, 95% CI 2.39 to 9.20). In conclusion, in patients who underwent percutaneous coronary intervention, the acuity of clinical presentation corresponds to an increase in ST incidence. Adherence to clopidogrel is critical to prevent ST in patients who underwent percutaneous coronary intervention, especially in STEMI.

Authors+Show Affiliations

Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24837256

Citation

Loh, Joshua P., et al. "Comparison of Outcomes After Percutaneous Coronary Intervention Among Different Coronary Subsets (stable and Unstable Angina Pectoris and ST-segment and non-ST-segment Myocardial Infarction)." The American Journal of Cardiology, vol. 113, no. 11, 2014, pp. 1794-801.
Loh JP, Pendyala LK, Kitabata H, et al. Comparison of outcomes after percutaneous coronary intervention among different coronary subsets (stable and unstable angina pectoris and ST-segment and non-ST-segment myocardial infarction). Am J Cardiol. 2014;113(11):1794-801.
Loh, J. P., Pendyala, L. K., Kitabata, H., Torguson, R., Omar, A., Minha, S., Chen, F., Satler, L. F., Pichard, A. D., & Waksman, R. (2014). Comparison of outcomes after percutaneous coronary intervention among different coronary subsets (stable and unstable angina pectoris and ST-segment and non-ST-segment myocardial infarction). The American Journal of Cardiology, 113(11), 1794-801. https://doi.org/10.1016/j.amjcard.2014.03.007
Loh JP, et al. Comparison of Outcomes After Percutaneous Coronary Intervention Among Different Coronary Subsets (stable and Unstable Angina Pectoris and ST-segment and non-ST-segment Myocardial Infarction). Am J Cardiol. 2014 Jun 1;113(11):1794-801. PubMed PMID: 24837256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of outcomes after percutaneous coronary intervention among different coronary subsets (stable and unstable angina pectoris and ST-segment and non-ST-segment myocardial infarction). AU - Loh,Joshua P, AU - Pendyala,Lakshmana K, AU - Kitabata,Hironori, AU - Torguson,Rebecca, AU - Omar,Alfazir, AU - Minha,Sa'ar, AU - Chen,Fang, AU - Satler,Lowell F, AU - Pichard,Augusto D, AU - Waksman,Ron, Y1 - 2014/03/15/ PY - 2014/01/08/received PY - 2014/03/06/revised PY - 2014/03/06/accepted PY - 2014/5/20/entrez PY - 2014/5/20/pubmed PY - 2014/7/9/medline SP - 1794 EP - 801 JF - The American journal of cardiology JO - Am J Cardiol VL - 113 IS - 11 N2 - Percutaneous coronary intervention in the setting of acute myocardial infarction is known to predict stent thrombosis (ST). This study aims to compare the ST rates across different coronary subsets. This was an observational cohort study from a large, single-center registry. Included were 12,198 consecutive patients who underwent percutaneous coronary intervention with stenting. Patients were categorized according to their clinical presentation: stable angina pectoris (SAP, n = 3,700), unstable angina pectoris (UAP, n = 2,845), non-ST-segment elevation myocardial infarction (NSTEMI, n = 4,083), and ST-segment elevation myocardial infarction (STEMI, n = 1,570). The study end points were ST rates at 1 year. Patients with STEMI were younger with a lower prevalence of cardiovascular risk factors, except for smoking. More type C lesions were treated in STEMI, whereas drug-eluting stents were used less frequently in patients with STEMI compared with the other groups. Definite ST at 1 year was highest in patients with STEMI (1.4%; vs SAP, 0.4%; UAP, 0.5%; NSTEMI, 0.5%; p <0.001). One-year definite/probable ST rates were SAP, 0.8%; UAP, 1.1%; NSTEMI, 1.4%; and STEMI, 3.2% (p <0.001). On multivariable analysis, STEMI independently predicts definite ST (hazards ratio [HR] 3.07, 95% confidence interval [CI] 1.32 to 7.10), whereas both STEMI (HR 3.36, 95% CI 1.84 to 6.12) and NSTEMI (HR 2.04, 95% CI 1.20 to 3.07) were independent predictors of definite/probable ST. Clopidogrel cessation was the strongest predictor of ST (definite ST, HR 17.00, 95% CI 7.54 to 38.31; definite/probable ST, HR 4.69, 95% CI 2.39 to 9.20). In conclusion, in patients who underwent percutaneous coronary intervention, the acuity of clinical presentation corresponds to an increase in ST incidence. Adherence to clopidogrel is critical to prevent ST in patients who underwent percutaneous coronary intervention, especially in STEMI. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/24837256/Comparison_of_outcomes_after_percutaneous_coronary_intervention_among_different_coronary_subsets__stable_and_unstable_angina_pectoris_and_ST_segment_and_non_ST_segment_myocardial_infarction__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(14)00796-6 DB - PRIME DP - Unbound Medicine ER -