Clinical Outcomes Following Stent Thrombosis Occurring In-Hospital Versus Out-of-Hospital

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:59

Article

Dangas, George D.^1,2  Claessen, Bimmer E.^2,3  Mehran, Roxana²  Brener, Sorin²  Brodie, Bruce R.⁴  Dudek, Dariusz⁵  Witzenbichler, Bernhard⁶  Peruga, Jan Z.⁷  Guagliumi, Giulio⁸  Moses, Jeffrey W.⁹  Lansky, Alexandra J.¹⁰  Xu, Ke²  Stone, Gregg W.² 

[1] Mt Sinai Med Ctr, Cardiovasc Inst, Dept Cardiol, 1 Gustave L Levy Pl,Box 1030, New York, NY 10029 USA

[2] Cardiovasc Res Fdn, New York, NY USA

[3] Univ Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, Netherlands

[4] LeBauer Cardiovasc Res Fdn, Dept Cardiol, Greensboro, NC USA

[5] Jagiellonian Univ, Dept Cardiol, Krakow, Poland

[6] Charite, Dept Cardiol, D-13353 Berlin, Germany

[7] Med Univ Lodz, Dept Cardiol, Lodz, Poland

[8] Osped Riuniti Bergamo, Dept Cardiol, I-24100 Bergamo, Italy

[9] Columbia Univ, Med Ctr, Dept Cardiol, New York, NY USA

[10] Yale Univ, Med Ctr, Dept Cardiol, New Haven, CT USA

关键词: PCI;    STEMI;    stent thrombosis;   

DOI  :  10.1016/j.jacc.2011.12.042

来源: Elsevier

【 摘 要 】

Objectives The study sought to determine whether rapid access to medical care and reperfusion results in a better prognosis in patients with in-hospital compared with out-of-hospital stent thrombosis (ST) in patients with ST-segment elevation myocardial infarction (STEMI) in the HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial. Background Whether the prognosis of in-hospital and out-of-hospital ST are similar is uncertain, with conflicting data reported from prior studies. Methods A total of 3,602 STEMI patients undergoing primary percutaneous coronary intervention (PCI) were randomized to bivalirudin (n = 1,800) versus unfractionated heparin (UFH) plus a glycoprotein IIb/IIIa inhibitor (GPI) (UFH + GPI; n = 1,802). Stents were implanted in 3,202 patients, 156 (4.9%) of whom developed Academic Research Consortium definite/probable ST during 3-year follow-up. We investigated the 1-year clinical outcomes after ST in 54 patients with in-hospital ST compared with 102 patients with out-of-hospital ST. Results One year after the ST event, patients with in-hospital compared with out-of-hospital ST had significantly greater mortality (27.8% vs. 10.8%, p < 0.01); most deaths in both groups occurred within 1 week of the ST event. Patients with in-hospital ST also had higher rates of major bleeding (21.2% vs. 6.0%, p < 0.01), but a lower rate of myocardial infarction (56.6% vs. 77.5%, p < 0.01). Subgroup analysis within both in-hospital and out-of-hospital ST groups indicated that subacute ST had the highest mortality. By multivariable analysis, 1-year mortality was significantly increased in patients with in-hospital compared with out-of-hospital ST (adjusted hazard ratio: 4.62, 95% confidence interval: 1.98 to 10.77, p < 0.01). Additional correlates of increased mortality after an ST event included diabetes and randomization to UFH + GPI (vs. bivalirudin). Conclusions Following primary PCI for STEMI, more than one-third of all ST events during 3-year follow-up occurred during the index hospital phase. Mortality and major bleeding were significantly higher after in-hospital ST compared with out-of-hospital ST. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966) (J Am Coll Cardiol 2012;59:1752-9) (C) 2012 by the American College of Cardiology Foundation

【 授权许可】

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