Stent Thrombosis After ACS-PCI: Does Adherence to Antiplatelet Therapy Involve More Than Its Intensity?
Abstrakt
As a result of the increasing prevalence of risk factors, coronary heart disease (CHD) has become a leading cause of death, globally, among people aged 60 years and older. The worldwide burden of CHD is set to reach 47 million disability-adjusted life years by 2020.1 A substantial linear decrease in the rates of coronary artery bypass graft surgery has been observed over the past 2 decades.
This decline has been accompanied by a corresponding increase in percutaneous coronary revascularization procedures such that most coronary artery lesions needing intervention are now treated with stents.2 It has been projected that the total number of percutaneous coronary intervention (PCI) procedures performed in Europe will grow at a compound annual rate of 3.5% over the next half-decade, and the global market forecast for coronary artery stents is expected to increase from 2016 to 2020 by 2.9%.3 Stent thrombosis (ST) is an infrequent complication of PCI in the setting of effectively suppressed platelet reactivity with aspirin and a P2Y12 inhibitor.4 The rate of serious ST-associated events, however, is worrying; every fourth patient with ST dies and a consequential myocardial infarction (MI) occurs in almost every patient. Treatment for ST requires emergent, repeat coronary intervention, although optimal reperfusion is only achieved in two-thirds of patients.
The risk of subsequent recurrent ST is high (5-year incidence = 24%).5 The highest mortality risk is among those with early ST. With the growth of the stented patient population, ST accounts for an increasing proportion of patients with ST-segment elevation MI.
A study using a large population of all-comers treated with coronary stents showed that more than 60% of patients readmitted with ST-segment elevation MI within the 5-year follow-up had definite ST.6 Taking all this into consideration and given the current shift toward an aging demographic structure, stenting will continue to be in demand and the issue of ST and its prevention will become increasingly important.