Clinical Impact of Intracoronary Imaging in the Management of Stent Thrombosis.

Autor: Karamasis GV; Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK.; School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK.; 2nd Cardiology Department, University of Athens, University Hospital Attikon, 124 62 Haidari, Greece., Katsikis A; Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK.; Cardiology Department, 401 General Military Hospital of Athens, 115 25 Athens, Greece., Konstantinou K; Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK.; School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK., Clesham GJ; Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK.; School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK., Kelly PA; Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK., Jagathesan R; Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK., Prati F; Cardiology Department, S. Giovanni Hospital, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy., Bourantas CV; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, Mile End Road, London E1 4NS, UK.; Institute of Cardiovascular Sciences, University College London, Gower Street, London WC1E 6BT, UK., Davies JR; Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK.; School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK., Keeble TR; Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK.; School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2024 Aug 09; Vol. 13 (16). Date of Electronic Publication: 2024 Aug 09.
DOI: 10.3390/jcm13164667
Abstrakt: Objectives: Use of intracoronary imaging (ICI) in cases of stent thrombosis (ST) is recommended and tailored treatment appears reasonable. Nevertheless, data supporting such a strategy are lacking. The aim of this study was to evaluate the clinical impact of ICI in the management of ST. Methods: The unadjusted study population was consecutive patients with definite ST presenting in a single tertiary cardiac centre and undergoing percutaneous coronary intervention (PCI). The presumed major mechanism of ST was assigned according to the real-time ICI interpretation by the PCI operator. Propensity score matching was performed with regard to ICI use to form the adjusted population and Kaplan-Meier analysis was applied to compare survival free of cardiac death (CD) or target lesion revascularization (TLR). Results: The unadjusted population included 130 ST patients, with the majority presenting with ST-elevation myocardial infarction (STEMI) (88%) and very late ST (86%). ICI was performed in 45 patients, of whom optical coherence tomography (OCT) was performed in 30 cases. When the individual ST mechanisms were viewed as groups, there was an interaction observed between type of treatment (stent vs. non-stent) and ST mechanism, with non-stent treatment being more prevalent in cases of underexpansion, malapposition, in-stent restenosis and mechanism uncertainty. After application of matching, two groups of 30 patients were formed. ICI-guided management resulted in better survival free of CD-TLR at 2 years (93% vs. 73%, p = 0.037). Conclusions: Intracoronary imaging guidance during PCI for ST had a direct impact on management (stent vs. non-stent) and resulted in a lower event rate at mid-term follow-up when propensity matched analysis was applied.
Databáze: MEDLINE
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