Contemporary Trends, Characteristics, and Outcomes of Patients Undergoing Percutaneous Coronary Intervention for Stent Thrombosis

Background There are limited data regarding the temporal trends and outcomes of stent thrombosis (ST) in the contemporary era of potent P2Y₁₂ inhibitors, newer generation drug-eluting stents, and intracoronary imaging. Objectives The aim of this study was to examine the trends, characteristics, and outcomes of patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) for ST in the United States. Methods Patients undergoing PCI for AMI between April 2018 and June 2023 were identified from the National Cardiovascular Data Registry CathPCI registry. The rates of PCI for ST were evaluated over time using linear regression. In-hospital outcomes of PCI for ST vs no ST were compared using multivariable logistic regression. Results Among 2,023,032 patients undergoing PCI for AMI, 57,268 (2.8%) procedures were for ST. The timing of ST was early (18,189 of 55,351 [31.8%]), late (8,825 of 55,351 [15.4%]), very late (28,337 of 55,351 [49.5%]), or unknown (1,917 of 55,351 [3.4%]). There was no temporal change in the frequency of PCI for ST during the study period. PCI for ST was associated with a higher incidence of major adverse cardiac events (adjusted OR [aOR]: 1.24; 95% CI: 1.19-1.29), all-cause mortality (aOR: 1.17; 95% CI: 1.12-1.22), recurrent myocardial infarction (aOR: 1.80; 95% CI: 1.63-1.98), and major bleeding (aOR: 1.18; 95% CI: 1.15-1.22) compared with PCI for non-ST. Conclusions In this contemporary, nationwide, real-world analysis, there was no temporal change in the frequency of PCI for ST. Most STs were early or very late. PCI for ST was associated with a higher rate of in-hospital adverse outcomes.