Stent thrombosis in acute myocardial infarction in the era of second-generation drug-eluting stent: incidence, prognosis, and historical comparisons with previous stent era.

Background: Stent thrombosis (ST) remains a serious complication after percutaneous coronary intervention, leading to acute myocardial infarction (AMI) in over 70% of cases. And it has been reported that the prognosis for ST is worse than for de-novo AMI. While the use of second-generation drug-eluting stents (G2-DES) has reduced ST incidence, ST remains a concern, and its incidence and prognosis in the G2-DES era have not been well studied.

Aims: To evaluate the incidence and prognosis of AMI due to ST in the G2-DES era compared with de-novo AMI.

Methods: From January 2013 to November 2022, we analyzed 6273 consecutive AMI patients from the Mie ACS Registry, including 78 ST and 6195 de-novo type 1 AMI (de-novo AMI) after exclusion of the other type of AMI. The primary endpoint was all-cause mortality, and target lesion revascularization (TLR) was the secondary endpoint.

Results: ST occurred in 1.2% (n = 78) of AMI, predominantly as very late ST (79.5%, n = 62). Thirty-day mortality was marginally lower in ST (2.6%) than de-novo AMI (6.7%, p = 0.16), with ST not being an independent predictor of 30-day mortality (HR 0.39, p = 0.19). However, ST patients had a higher 2-year TLR rate (21.4% vs. 11.9%, p = 0.02), confirmed as an independent predictor (HR 2.03, p = 0.01). Compared to previous clinical data, the reduced incidence of ST and the improved prognosis was observed.

Conclusions: While ST-related AMI prognosis has improved, with mortality comparable to de-novo AMI, the higher TLR rate in ST patients persists, and an optimized revascularization strategy is still needed.