Analysis of risk factors for early stent thrombosis in the Chinese population: A multicenter restrospective study

doi:10.5847/wjem.j.1920-8642.2021.03.005

World Journal of Emergency Medicine ›› 2021, Vol. 12 ›› Issue (3): 192-197.doi: 10.5847/wjem.j.1920-8642.2021.03.005

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Analysis of risk factors for early stent thrombosis in the Chinese population: A multicenter restrospective study

Yu-peng Wang¹, Lei Ding¹, Rui-tao Zhang¹, Xiao-zeng Wang², Dan-qing Yu³, Shou-yan Hao⁴, Jin-wei Tian⁵, Zhen-yu Liu⁶, Xiang-qian Qi⁷, Hu Tan⁸, Hong-yi Wu⁹, Feng-hua Ding¹⁰, Li-jun Guo¹(), Ya-ling Han²()

¹ Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptor Research, Beijing 100191, China
² Department of Cardiology, General Hospital of Northern Theatre Command, Shenyang 110016, China
³ Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
⁴ Department of Cardiology, the First Hospital of Jilin University, Changchun 130021, China
⁵ Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin 150001, China
⁶ Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
⁷ TEDA International Cardiovascular Hospital, Tianjin 300457, China
⁸ Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing 400037,China
⁹ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
¹⁰ Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China

Received:2020-12-12 Accepted:2021-05-05 Online:2021-06-01 Published:2021-05-31
Contact: Li-jun Guo,Ya-ling Han E-mail:guo_li_jun@126.com;hanyaling@263.net

Abstract

Abstract:

BACKGROUND: The predictive scoring systems for early stent thrombosis (EST) remains blank in China. The study aims to evaluate the risk factors and conduct a prediction model of EST in the Chinese population.

METHODS: EST was defined as thrombosis that occurs within the first 30 days after primary percutaneous coronary intervention (PCI). Patients from ten Chinese hospitals diagnosed as stent thrombosis (ST) from January 2010 to December 2016 were retrospectively included as the study group. A control group (1 case:2 controls) was created by including patients without ST, major adverse cardiovascular events, or cerebrovascular events during follow-up. The present study evaluated 426 patients with single-vessel lesions and ultimately included 40 patients with EST and 80 control patients, who were included to identify factors that predicted EST and to develop a prediction scoring system. The other 171 patients without integrated 1:2 pair were used for external validation.

RESULTS: EST was independently associated with a low hemoglobin concentration (adjusted odds ratio [OR] 0.946, 95% confidence interval [95% CI] 0.901-0.993, P=0.026), a high pre-PCI Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (OR 1.166, 95% CI 1.049-1.297, P=0.004), and a DAPT (DAPT) duration of <30 days (OR 28.033, 95% CI 5.302-272.834, P<0.001). The simple EST prediction score provided an area under the curve (AUC) of 0.854 (95% CI 0.777-0.932, P<0.001) with 70.0% sensitivity and 90.0% specificity, and 0.742 (95% CI 0.649-0.835, P<0.001) with 54.5% sensitivity and 81.0% specificity for external validation dataset.

CONCLUSIONS: EST may be independently associated with DAPT discontinuation within 30 days, a low hemoglobin concentration, and a high SYNTAX score. The scoring system also has a good ability to predict the risk of EST and may be useful in the clinical setting.

Key words: Coronary heart disease, Stent thrombosis, Risk stratification, Predictive scoring system

Yu-peng Wang, Lei Ding, Rui-tao Zhang, Xiao-zeng Wang, Dan-qing Yu, Shou-yan Hao, Jin-wei Tian, Zhen-yu Liu, Xiang-qian Qi, Hu Tan, Hong-yi Wu, Feng-hua Ding, Li-jun Guo, Ya-ling Han. Analysis of risk factors for early stent thrombosis in the Chinese population: A multicenter restrospective study[J]. World Journal of Emergency Medicine, 2021, 12(3): 192-197.

Figures/Tables 3

Table 1

Baseline clinical characteristics of EST group and control group

Variables	EST group (n=40)	Control group (n=80)	Univariate OR	P-value
Age, years, mean±SD	65.1±9.5	61.8±9.7	1.034	0.100
Male, n (%)	30 (75.0)	58 (72.5)	0.858	0.752
Hypertension, n (%)	25 (70.0)	42 (52.5)	2.146	0.071
Diabetes mellitus, n (%)	14 (35.0)	25 (31.3)	1.188	0.678
Hyperlipidemia, n (%)	11 (27.5)	17 (21.3)	1.542	0.394
Current smoker, n (%)	20 (50.0)	37 (46.3)	1.208	0.665
Family history of premature CAD, n (%)	2 (5.0)	4 (5.0)	1.000	1.000
Hemoglobin, g/L, mean±SD	131.6±15.2	140.0±14.3	0.950	0.003^*
Activated partial thromboplatin time, seconds, mean±SD	31.6±7.6	31.7±6.2	0.995	0.900
NLR, mean±SD	4.6±2.8	3.3±2.4	1.205	0.019^*
Total bilirubin, μmol/L, mean±SD	14.4±7.4	11.8±4.0	1.095	0.021^*
HDL-C, mmol/L, mean±SD	1.1±0.2	1.1±0.3	1.337	0.698
LDL-C, mmol/L, mean±SD	2.8±1.2	2.5±0.8	1.407	0.113
Triglyceride, mmol/L, mean±SD	1.6±0.9	1.6±1.0	0.946	0.804
Cholesterol, mmol/L, mean±SD	4.4±1.3	4.1±1.0	1.263	0.228
Fasting blood glucose, mmol/L, mean±SD	7.8±3.8	6.4±2.0	1.263	0.019^*
Duration of DAPT <30 days, n (%)	18 (45.0)	3 (3.8)	17.271	<0.001^*
Duration of LMWH, n (%)
Not use	20 (50.0)	52 (65.0)		0.060
≤3 days	11 (27.5)	12 (15.0)	14.448	0.019^*
>3 days	9 (22.5)	16 (20.0)	9.156	0.086
Type of lesions^a, n (%)
A+B1	2 (5.0)	3 (3.8)		0.505
B2	10 (25.0)	28 (35.0)	0.558	0.543
C	28 (70.0)	49 (61.3)	0.969	0.973
Bifurcation lesion, n (%)	17 (42.5)	29 (36.3)	1.281	0.519
Total occlusive lesion, n (%)	12 (30.0)	15 (18.8)	1.757	0.189
Pre-PCI SYNTAX score, mean±SD	17.0±10.3	10.3±7.2	1.097	0.001^*
Pre-PCI reference vessel diameter, mm, mean±SD	2.7±0.4	2.8±0.6	0.638	0.260
MLD, mm, mean±SD
Before intervention	0.5±0.5	0.7±0.5	0.496	0.073
After intervention	2.2±0.5	1.6±0.6	0.581	0.133
Luminal net gain, mm, mean±SD	1.6±0.7	1.6±0.6	1.038	0.898
Stent length, mm, mean±SD	32.9±13.7	28.8±11.7	1.032	0.076
MSD, mm, mean±SD	2.4±0.4	2.6±0.5	0.494	0.102
Length of stent, mm, mean±SD	2.8±0.4	3.0±0.5	0.580	0.245
Post-dilation, n (%)	23 (57.5)	46 (57.5)	1.000	1.000

Table 1

Table 2

Figure 1.

References 14

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Variables	β	Adjusted OR (95% CI)	Adjusted P-value
Hemoglobin	-0.055	0.946 (0.901-0.993)	0.026
Duration of DAPT <30 days	3.638	28.033 (5.302-272.834)	<0.001
Pre-PCI SYNTAX score	0.154	1.166 (1.049-1.297)	0.004

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Analysis of risk factors for early stent thrombosis in the Chinese population: A multicenter restrospective study

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