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Aims: To investigate the efficacy and outcome of emergency percutaneous coronary interventions(PCI) in patients with stent thrombosis. Methods and results: Between 1995 and 2003, 6058 patients underwent bare-metal stent implantation, of which 95(1.6%) patients suffered from stent thrombosis. The timing of stent thrombosis was acute in 10(11%), subacute in 61(64%), and late in 24(25%) patients. Procedural and clinical outcomes of emergency PCI for treatment of stent thrombosis were investigated. Emergency PCI was successful in 86(91%), complicated by death in 2(2%), and coronary artery bypass grafting in 2(2%) patients. Myocardial infarction occurred in 77(81%) patients with a peak creatine kinase level of 1466±1570 U/L. Left ventricular ejection fraction declined from 0.54±0.19 prior to 0.48±0.16(P< 0.05) at the time of stent thrombosis after emergency PCI. A 6 month major adverse clinical events comprised death(11%), reinfarction(16%), and recurrent stent thrombosis(12%) after emergency PCI. Multivariable logistic regression analysis identified the achievement of TIMI 3 flow(OR=0.1, CI 95%0.01-0.54, P< 0.001) and diameter stenosis< 50%(OR=0.06, CI 95%0.01-0.32, P< 0.001) during emergency PCI to be independently associated with a reduced risk of cardiac death. Recurrent stent thrombosis was independently predicted by the omission of abciximab(OR=4.3, CI 95%1.1-17.5). Conclusion: Emergency PCI for treatment of stent thrombosis effectively restores vessel patency and flow. Patients presenting with stent thrombosis are at risk for recurrent myocardial infarction and recurrent stent thrombosis.
Aims: To investigate the efficacy and outcome of emergency percutaneous coronary interventions (PCI) in patients with stent thrombosis. Methods and results: Between 1995 and 2003, 6058 patients underwent bare-metal stent implantation, of which 95 (1.6%) patients suffered from The timing of stent thrombosis was acute in 10 (11%), subacute in 61 (64%), and late in 24 (25%) patients. Procedural and clinical outcomes of emergency PCI for treatment of stent thrombosis were investigated. Emergency PCI was successful in 86 (91%), complicated by death in 2 (2%), and coronary artery bypass grafting in 2 (2%) patients. Myocardial infarction occurred in 77 (81%) patients with a peak creatine kinase level of 1466 ± 1570 U / L. Left ventricular ejection fraction declined from 0.54 ± 0.19 prior to 0.48 ± 0.16 (P <0.05) at the time of stent thrombosis after emergency PCI. A 6 month major adverse clinical events complicated died (11%) , reinfarction (16%), and recurrent stent thrombosis (12%) after emer gency PCI. Multivariable logistic regression analysis identified the achievement of TIMI 3 flow (OR = 0.1, CI 95% 0.01-0.54, P <0.001) and diameter stenosis <50% 0.001) during emergency PCI to be associated associated with reduced risk of cardiac death. Recurrent stent thrombosis was independently predicted by the omission of abciximab (OR = 4.3, CI 95% 1.1-17.5). Conclusion: Emergency PCI for treatment of stent thrombosis effectively restores vessel patency and flow. Patients presenting with stent thrombosis are at risk for recurrent myocardial infarction and recurrent stent thrombosis.