Association of Periprocedural Inflammatory Activation With Increased Risk for Early Coronary Stent Thrombosis
Background Stent thrombosis is a rare but deleterious event. Routine coronary angiography with percutaneous coronary intervention (PCI) is often deferred in the presence of laboratory markers of acute inflammation to prevent complications. The aim of this study was to investigate whether an acute in...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.032300 |
| _version_ | 1797296311067738112 |
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| author | Konstantin A. Krychtiuk Konstantin Bräu Stephanie Schauer Alexander Sator Lukas Galli Andreas Baierl Christian Hengstenberg Clemens Gangl Irene M. Lang Christian Roth Rudolf Berger Walter S. Speidl |
| author_facet | Konstantin A. Krychtiuk Konstantin Bräu Stephanie Schauer Alexander Sator Lukas Galli Andreas Baierl Christian Hengstenberg Clemens Gangl Irene M. Lang Christian Roth Rudolf Berger Walter S. Speidl |
| author_sort | Konstantin A. Krychtiuk |
| collection | DOAJ |
| description | Background Stent thrombosis is a rare but deleterious event. Routine coronary angiography with percutaneous coronary intervention (PCI) is often deferred in the presence of laboratory markers of acute inflammation to prevent complications. The aim of this study was to investigate whether an acute inflammatory state is associated with an increased risk of early stent thrombosis. Methods and Results Within a prospective single‐center registry, the association between preprocedural acute inflammatory activation, defined as C‐reactive protein plasma levels >50 mg/L or a leukocyte count >12 g/L, and occurrence of early (≤30 days) stent thrombosis was evaluated. In total, 11 327 patients underwent PCI and of those, 6880 patients had laboratory results available. 49.6% of the study population received PCI for an acute coronary syndrome and 50.4% for stable ischemic heart disease. In patients with signs of acute inflammatory activation (24.9%), PCI was associated with a significantly increased risk for stent thrombosis (hazard ratio, 2.89; P<0.00001), independent of age, sex, kidney function, number and type of stents, presence of multivessel disease, choice of P2Y12 inhibitor, and clinical presentation. Elevated laboratory markers of acute inflammation were associated with the occurrence of stent thrombosis in both patients with acute coronary syndrome (hazard ratio, 2.63; P<0.001) and in patients with stable ischemic heart disease (hazard ratio, 3.57; P<0.001). Conclusions An acute inflammatory state at the time of PCI was associated with a significantly increased risk of early stent thrombosis. Evidence of acute inflammation should result in deferred PCI in elective patients, while future studies are needed for patients with acute coronary syndrome. |
| first_indexed | 2024-03-07T22:02:48Z |
| format | Article |
| id | doaj.art-f55ede881d244bb1ab28a86a815f9a1f |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T22:02:48Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f55ede881d244bb1ab28a86a815f9a1f2024-02-24T04:04:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-01-0113210.1161/JAHA.122.032300Association of Periprocedural Inflammatory Activation With Increased Risk for Early Coronary Stent ThrombosisKonstantin A. Krychtiuk0Konstantin Bräu1Stephanie Schauer2Alexander Sator3Lukas Galli4Andreas Baierl5Christian Hengstenberg6Clemens Gangl7Irene M. Lang8Christian Roth9Rudolf Berger10Walter S. Speidl11Department of Internal Medicine II–Division of Cardiology Medical University of Vienna Vienna AustriaDepartment of Internal Medicine II–Division of Cardiology Medical University of Vienna Vienna AustriaDepartment of Internal Medicine II–Division of Cardiology Medical University of Vienna Vienna AustriaDepartment of Internal Medicine II–Division of Cardiology Medical University of Vienna Vienna AustriaDepartment of Internal Medicine II–Division of Cardiology Medical University of Vienna Vienna AustriaDepartment of Statistics and Operations Research University of Vienna Vienna AustriaDepartment of Internal Medicine II–Division of Cardiology Medical University of Vienna Vienna AustriaDepartment of Internal Medicine II–Division of Cardiology Medical University of Vienna Vienna AustriaDepartment of Internal Medicine II–Division of Cardiology Medical University of Vienna Vienna AustriaDepartment of Internal Medicine II–Division of Cardiology Medical University of Vienna Vienna AustriaDepartment of Internal Medicine I Cardiology and Nephrology, Hospital of St. John of God Eisenstadt AustriaDepartment of Internal Medicine II–Division of Cardiology Medical University of Vienna Vienna AustriaBackground Stent thrombosis is a rare but deleterious event. Routine coronary angiography with percutaneous coronary intervention (PCI) is often deferred in the presence of laboratory markers of acute inflammation to prevent complications. The aim of this study was to investigate whether an acute inflammatory state is associated with an increased risk of early stent thrombosis. Methods and Results Within a prospective single‐center registry, the association between preprocedural acute inflammatory activation, defined as C‐reactive protein plasma levels >50 mg/L or a leukocyte count >12 g/L, and occurrence of early (≤30 days) stent thrombosis was evaluated. In total, 11 327 patients underwent PCI and of those, 6880 patients had laboratory results available. 49.6% of the study population received PCI for an acute coronary syndrome and 50.4% for stable ischemic heart disease. In patients with signs of acute inflammatory activation (24.9%), PCI was associated with a significantly increased risk for stent thrombosis (hazard ratio, 2.89; P<0.00001), independent of age, sex, kidney function, number and type of stents, presence of multivessel disease, choice of P2Y12 inhibitor, and clinical presentation. Elevated laboratory markers of acute inflammation were associated with the occurrence of stent thrombosis in both patients with acute coronary syndrome (hazard ratio, 2.63; P<0.001) and in patients with stable ischemic heart disease (hazard ratio, 3.57; P<0.001). Conclusions An acute inflammatory state at the time of PCI was associated with a significantly increased risk of early stent thrombosis. Evidence of acute inflammation should result in deferred PCI in elective patients, while future studies are needed for patients with acute coronary syndrome.https://www.ahajournals.org/doi/10.1161/JAHA.122.032300coronary stent thrombosisC‐reactive proteininflammationleukocyte countPCIstent |
| spellingShingle | Konstantin A. Krychtiuk Konstantin Bräu Stephanie Schauer Alexander Sator Lukas Galli Andreas Baierl Christian Hengstenberg Clemens Gangl Irene M. Lang Christian Roth Rudolf Berger Walter S. Speidl Association of Periprocedural Inflammatory Activation With Increased Risk for Early Coronary Stent Thrombosis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary stent thrombosis C‐reactive protein inflammation leukocyte count PCI stent |
| title | Association of Periprocedural Inflammatory Activation With Increased Risk for Early Coronary Stent Thrombosis |
| title_full | Association of Periprocedural Inflammatory Activation With Increased Risk for Early Coronary Stent Thrombosis |
| title_fullStr | Association of Periprocedural Inflammatory Activation With Increased Risk for Early Coronary Stent Thrombosis |
| title_full_unstemmed | Association of Periprocedural Inflammatory Activation With Increased Risk for Early Coronary Stent Thrombosis |
| title_short | Association of Periprocedural Inflammatory Activation With Increased Risk for Early Coronary Stent Thrombosis |
| title_sort | association of periprocedural inflammatory activation with increased risk for early coronary stent thrombosis |
| topic | coronary stent thrombosis C‐reactive protein inflammation leukocyte count PCI stent |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.032300 |
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