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Rangé G, Hakim R, Etienne CS, Deballon R, Dechery T, Souteyrand G, Bar O, Albert F, Canville A, Gamet A, Beygui F, Viallard L, Bonnet P, Durand E, Lesault PF, Boiffard E, Koning R, Benamer H, Commeau P, Cayla G, Motreff P. [stent thrombosis : A won battle ? (data from the France PCI registry)]. Ann Cardiol Angeiol (Paris) 2021; 70:388-394. [PMID: 34686307 DOI: 10.1016/j.ancard.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
GOAL The aim of the study is to assess the incidence, risk factors and prognosis of definite stent thrombosis (ST) at 1 year in the France PCI multicenter prospective registry. PATIENTS AND METHODS Only patients who underwent coronary angioplasty with at least one stent implantation between 1st January 2014 and 31 December 2019 were included. The population was separated into 2 groups: the "ST" group with stent thrombosis and the "control" group without stent thrombosis. RESULTS 35,435 patients were included. 256 patients (0.72%) presented a ST at 1 year. The rate of ST decreased significantly in acute coronary syndrome (1.5% in 2014 vs. 0.73% in 2019; p = 0.05) but not in chronic coronary syndrome (0.46% in 2014 vs 0.40%; p = 0.98). The risk factors are young age (65.8 years vs 68.2; p = 0.002), clinical context (35.27% vs 16.68%; p = 0.0001), diabetes (35.2 % vs 26.4%; p = 0.002), renal failure (11.7% vs 8%; p = 0.009) and history of coronary angioplasty (28.63% vs 21.86%; p = 0.009) and peripheral arterial disease (14.5% vs 10.1%; p = 0.021), LV dysfunction (37% vs 27.5%; p = 0.003), mean length (39.6 mm vs 31, 7mm; p <0.0001) and the mean number of stents per procedure (1.9 vs 1.6; p <0.0001), a TIMI flow ≤1 pre procedure (21.5% vs 12.4%; p <0.0001) and an intrastent restenosis (11% vs 6%; p <0.0001). The 1-year mortality of the ST group was significantly higher than that of the control group (19.14% vs 5.82%; p <0.0001). CONCLUSION Since 2014, the incidence of ST at 1 year has been decreasing but remains stuck at a floor level of 0.54% in 2019. The battle for ST seems to have been partly won and its risk factors well identified, but its mortality is still high.
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Affiliation(s)
- G Rangé
- Hôpitaux de Chartres, Service de Cardiologie, 4 rue Claude Bernard 28630 Le Coudray.
| | - R Hakim
- Hôpitaux de Chartres, Service de Cardiologie, 4 rue Claude Bernard 28630 Le Coudray
| | - C Saint Etienne
- Service de cardiologie, Centre Hospitalo-Universitaire de Tours, 37170 Chambray les Tours, France
| | - R Deballon
- Service de cardiologie, Pôle santé Oréliance, 45770 Saran, France
| | - T Dechery
- Service de cardiologie, Centre Hospitalier Jacques-Cœur, 18020 Bourges, France
| | - G Souteyrand
- Service de cardiologie, Centre Hospitalo-Universitaire Gabriel-Montpied, 63000 Clermont Ferrand, France
| | - O Bar
- Service de cardiologie, Nouvelle Clinique Tours Plus, 37541 Saint Cyr sur Loire, France
| | - F Albert
- Hôpitaux de Chartres, Service de Cardiologie, 4 rue Claude Bernard 28630 Le Coudray
| | - A Canville
- Service de cardiologie, Clinique Saint-Hilaire, 76000 Rouen, France
| | - A Gamet
- Service de cardiologie, Centre Hospitalier Régional d'Orléans, 45100 Orléans, France
| | - F Beygui
- Service de cardiologie, Centre Hospitalo-Universitaire de Caen, 14033 Caen, France
| | - L Viallard
- Service de cardiologie, Centre Hospitalier Henri-Mondor, 15000 Aurillac, France
| | - P Bonnet
- Service de cardiologie, Groupe Hospitalier du Havre, 76290 Montivilliers, France
| | - E Durand
- Service de cardiologie, Centre Hospitalo-Universitaire de Rouen, 76038 Rouen, France
| | - P-F Lesault
- Service de cardiologie, Hôpital Privé de l'Estuaire, 76600 Le Havre, France
| | - E Boiffard
- Service de cardiologie, Centre Hospitalier Départemental de Vendée, 85000 La Roche-Sur-Yon, France
| | - R Koning
- Service de cardiologie, Clinique Saint-Hilaire, 76000 Rouen, France
| | - H Benamer
- Service de cardiologie, ICVGVM La Roseraie, 93300 Aubervilliers, France
| | - P Commeau
- Service de cardiologie, Polyclinique des Fleurs, 83190 Ollioules, France
| | - G Cayla
- Service de cardiologie, CHU Nîmes, Université Montpellier, Nîmes, France
| | - P Motreff
- Service de cardiologie, Centre Hospitalo-Universitaire Gabriel-Montpied, 63000 Clermont Ferrand, France
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[Optimal duration of dual antiplatelet therapy after coronary stent placement or acute coronary syndrome. Is customisation possible?]. Ann Cardiol Angeiol (Paris) 2019; 68:347-357. [PMID: 31471043 DOI: 10.1016/j.ancard.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022]
Abstract
The recommended 6-month dual antiplatelet therapy (DAPT) after coronary angioplasty with implantation of a drug eluting stent is based on solid evidence, but must take into account continuous improvements in stent technology leading to reduced thrombogenicity. In stable patients with a high hemorrhagic risk, it is possible to reduce DAPT duration at 3 months without significant increase in the risks of ischemic events or stent thrombosis. Further reduction toward a 1-month DAPT is likely to involve new strategies of stopping aspirin at 1 month, and continuing long-term monotherapy with inhibitors of P2Y12 receptor. After acute coronary syndrome, it seems possible to reduce the duration of DAPT (standard, 12 months) in patients at high risk of bleeding. A 6-month DAPT, or even less, provides a good compromise between hemorrhagic risk and ischemic recurrences. Conversely, in patients who have fully tolerated a 12-month DAPT after infarction, and who are at very high risk of ischemic recurrence, the prolongation of a P2Y12 inhibitor in combination with aspirin may be considered, with a risk of haemorrhage almost double. A certain degree of customisation of the duration of DAPT is therefore possible, based on age, renal function, comorbidities, haemorrhagic history, and the use of risk scores (PRECISE-DAPT, DAPT).
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