Contemporary Trends, Characteristics, and Outcomes of Patients Undergoing Percutaneous Coronary Intervention for Stent Thrombosis (JACC Cardiovascular Interventions March 2026)-Article: Contemporary Trends, Characteristics, and Outcomes of Patients Undergoing Percutaneous Coronary Intervention for Stent Thrombosis

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

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This U.S. nationwide registry study examined contemporary trends, patient characteristics, and in-hospital outcomes of percutaneous coronary intervention (PCI) performed for stent thrombosis (ST) among patients presenting with acute myocardial infarction (AMI) from April 2018 through June 2023. Using the National Cardiovascular Data Registry (NCDR) CathPCI Registry, investigators analyzed 2,023,032 AMI patients undergoing PCI; 57,268 procedures (2.8%) were performed for ST. ST timing was most often very late (≥365 days after index PCI) at 49.5%, followed by early ST (≤30 days) at 31.8%, and late ST (31–365 days) at 15.4% (timing unknown in 3.4%). There was no significant temporal change in the frequency of PCI for ST over the study period, including when stratified by ST timing.<br /><br />Compared with AMI patients undergoing PCI without ST, those treated for ST were slightly younger and more often male, current smokers, and had more comorbidities (eg, hypertension, diabetes, prior MI, cerebrovascular disease, peripheral arterial disease, prior heart failure, and prior CABG). They also presented with higher acuity, including more STEMI, cardiogenic shock, cardiac arrest, and arrhythmias. Procedurally, ST cases more often involved femoral access, left anterior descending (LAD) culprit lesions, poor pre-PCI TIMI flow, and more frequent use of glycoprotein IIb/IIIa inhibitors, cangrelor, potent P2Y12 inhibitors, and thrombus aspiration.<br /><br />After multivariable adjustment, PCI for ST was associated with worse in-hospital outcomes versus non-ST PCI, including higher major adverse cardiac events (aOR 1.24), mortality (aOR 1.17), recurrent MI (aOR 1.80), and major bleeding (aOR 1.18), with no adjusted difference in stroke. Among ST patients, strongest predictors of in-hospital MACE included cardiogenic shock, cardiac arrest, chronic kidney disease, older age, STEMI presentation, LAD culprit, and femoral access; male sex and radial access were associated with lower risk. The authors conclude that ST rates have not declined in the contemporary era and remain linked to substantial in-hospital risk, highlighting need for improved prevention and management strategies.

Keywords

stent thrombosis

percutaneous coronary intervention

acute myocardial infarction

NCDR CathPCI Registry

in-hospital outcomes

major adverse cardiac events

cardiogenic shock

STEMI presentation

very late stent thrombosis

bleeding complications