Stent Thrombosis: Current Management and Outcomes

Prognostic significance of prior ischemic stroke in patients with coronary artery disease undergoing percutaneous coronary intervention

OBJECTIVES

To investigate the long-term outcomes of percutaneous coronary intervention (PCI) in patients with previous ischemic stroke.

BACKGROUND

Ischemic stroke and coronary artery disease (CAD) are leading causes of death that often coexist with each other. With the increased use of PCI in high-risk patients with CAD, the association between prior ischemic stroke and cardiovascular/cerebrovascular events in patients with CAD undergoing PCI has been a topic of interest.

METHODS

We enrolled 10,300 consecutive patients who had undergone PCI from January 2013 to December 2013 and classified them into the prior ischemic stroke group (n = 1,106) and no prior ischemic stroke group (n = 9,194). The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCEs) during follow-up. The secondary endpoints included each component of the primary endpoint and stent thrombosis (ST).

RESULTS

Overall, 10.7% patients had a history of ischemic stroke. At a median 29-month follow-up, MACCEs following PCI occurred with 2-year incidences of 15.4% in the prior ischemic stroke group and 11.7% in the no prior ischemic stroke group. Cox regression analysis demonstrated that prior ischemic stroke was independently associated with a higher risk of MACCEs (adjusted hazard ratio [HR] = 1.294; 95% confidence interval [CI]: 1.100-1.522; P = 0.002), recurrent stroke (adjusted HR = 2.463; 95% CI: 1.729-3.507; P = 0.000), and ST (adjusted HR = 1.787; 95% CI: 1.075-2.971; P = 0.025). A high residual syntax score and low renal function were independent risk factors for MACCEs.

CONCLUSIONS

Increased concern and active treatment strategies are needed in patients undergoing PCI who have a history of ischemic stroke.

Inhibitory effects of ASP6537, a selective cyclooxygenase-1 inhibitor, on thrombosis and neointima formation in rats

INTRODUCTION

Percutaneous coronary interventions (PCIs), such as balloon angioplasty and stent placement, are effective in the treatment of coronary artery disease. PCI has drawbacks, however, including acute thrombosis after the procedure and restenosis of the vascular lumen due to abnormal neointimal hyperplasia. ASP6537 is a selective COX-1 inhibitor that has been investigated as a possible candidate for clinical development as an antiplatelet agent. In the present study, we evaluated the in vivo antithrombotic effect of ASP6537 and its effect on neointima formation after balloon angioplasty.

MATERIAL AND METHODS

The antithrombotic effect of ASP6537 was examined using an arteriovenous shunt thrombosis model in rats while the effect of ASP6537 on neointima formation was evaluated in a rat carotid arterial balloon angioplasty model.

RESULTS

In the thrombosis study, ASP6537 dose-dependently decreased the protein content of the thrombus, while no prolongation of template bleeding time was observed. In the neointima study, ASP6537 reduced neointima formation.

CONCLUSIONS

ASP6537 may be a promising agent for the prevention of acute thrombosis and restenosis after PCI in place of aspirin.

ST-Segment Elevation Myocardial Infarction with Acute Stent Thrombosis Presenting as Intractable Hiccups: An Unusual Case

Patient: Male, 51

Final Diagnosis: ST-segment elevation myocardial infarction with acute stent thrombosis

Symptoms: Chest pain • hiccups

Medication: —

Clinical Procedure: —

Specialty: Cardiology