Intraprocedural ST Predicts Adverse Short-Term Events

San Francisco, CA—Intraprocedural stent thrombosis (ST) during PCI is a strong independent predictor of adverse short-term clinical outcomes that carries serious implications for patients, including the potential to double length of hospital stay, according to an analysis of data from the CHAMPION PHOENIX trial, which was simultaneously published in the Journal of the American College of Cardiology.

 

philip.tues.29Intraprocedural ST (IPST) — defined as angiographically new or worsening thrombus related to stent implantation during PCI — was associated with increased risk for death, MI, Academic Research Consortium (ARC) stent thrombosis and other adverse events at both 48 hours and 30 days (see Figure 1). The data were presented at TCT 2013 by Philippe Généreux, MD, of Columbia University Medical Center and the Cadiovascular Research Foundation.

 

Independent predictor 

The CHAMPION PHOENIX trial, originally published in the New England Journal of Medicine, randomly assigned 10,942 patients undergoing either urgent or elective PCI who were receiving guideline-recommended therapy to receive either a bolus infusion of cangrelor (The Medicines Company; n = 5,472) or a loading dose of 600 mg or 300 mg of clopidogrel (n=5,470).

Intraprocedural ST incidence, a secondary efficacy outcome, was lower with cangrelor compared with clopidogrel (0.6% vs. 1%; P=.04).

Généreux and colleagues then further analyzed data to evaluate the incidence, predictors and clinical impact of intraprocedural ST.

Overall, 89 patients (0.8%) developed intraprocedural ST. Of these, 48 (53.9%) had new thrombus and 41 (46.1%) had worsening thrombus. Intraprocedural ST rates were 0.5% (n=32) in stable CAD, 1.2% (n=33) in non-ST–elevated ACS (NSTE-ACS), and 1.2% (n=24) in STEMI.

Several independent predictors of intraprocedural ST were identified, including NSTE-ACS (adjusted OR 2.07; P=.004); STEMI (adjusted OR 1.87; P=.04); thrombus at baseline (adjusted OR 1.79; P=.01); and total stent length (adjusted OR 1.03 per 1 mm increase; P<.0001).

The results also showed cangrelor use was an independent predictor of freedom from intraprocedural ST.

 The effects of cangrelor in reducing IPST was consistent across all modes of presentation (see Figure 2). “This finding may have major implications when we have to select the most potent antithrombotic treatment during PCI,” Généreux said.

 

intra.1.tues.29Rare but important

The detrimental effects of intraprocedural ST — a rare event reported in about 1% of patients — persisted after resolution of TIMI 3 flow.

 

Among that subgroup, patients who developed intraprocedural ST had a higher composite rate of death, ARC Definite ST, ischemic-driven revascularization and MI at 48 hours (adjusted OR 10.24; 95% CI 5.64-18.6; P<.0001) and at 30 days (adjusted OR 8.85; 95% CI 5-15.65; P<.0001).

Patients with intraprocedural ST also had considerably longer lengths of stay after PCI compared with those without the event (45.6 hours vs. 27 hours; P<.0001).

“These data provide strong evidence to support the inclusion of IPST as an important endpoint in future pharmacologic or device trials,” Généreux said. 


 

 

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Disclosures:

Généreux reported no relevant conflicts of interest.

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