Abstract

JACC

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TCTAP A-009

Coronary Stent Thrombosis Prediction in Patients with Acute Coronary Syndrome

By Roman Risberg, Vladimir Plechev, Bogdan Oleynik, Vali Yunusov

Presenter

Roman Risberg

Authors

Roman Risberg1, Vladimir Plechev2, Bogdan Oleynik2, Vali Yunusov2

Affiliation

Republican Cardiology Center, Russian Federation1, Bashkir State Medical University, Russian Federation2
View Study Report
TCTAP A-009
Acute Coronary Syndromes (STEMI, NSTE-ACS)

Coronary Stent Thrombosis Prediction in Patients with Acute Coronary Syndrome

Roman Risberg1, Vladimir Plechev2, Bogdan Oleynik2, Vali Yunusov2

Republican Cardiology Center, Russian Federation1, Bashkir State Medical University, Russian Federation2

Background

On the basis of instrumental and laboratory methods, to determine the prognosis of the development of coronary stent thrombosis in acute coronary syndrome.


Methods

To achieve the aim of the study, we analyzed the treatment of 4028 patients who underwent urgent coronary stenting. In 4028 patients who underwent percutaneous stenting of coronary vessels, postoperative complications occurred in 285 (7%), including 59 cases (20.7%) - coronary stent thrombosis in the early postoperative period,in 226 cases (79.3 %) - restenosis in the coronary stent in the late postoperative period.

Results

A preliminary correlation analysis revealed the relationship between the risk of coronary stent thrombosis in acute coronary syndrome and echocardiographic data, as well as laboratory parameters (Tables 1, 2).

Based on the results of logistic regression of continuous signs, a prognostic model of the development of coronary stent thrombosis in the early postoperative period after emergency stenting of coronary vessels was constructed.

The probability (p) of coronary stent thrombosis in the early postoperative period based on this prognosis model is:

p = 1 / (1+ eFV * 0.024 + APTT * 0.071 + 0.603),

Where "e" is the base of the natural logarithm, a mathematical constant of approximately 2.718. The correctness of the forecast model is 98.7%.

The closer the value is to 1, the higher the risk of this postoperative complication. For convenience, the result can be multiplied by 100%. So, for example, with EF = 65% and APTT = 35 sec, the risk of coronary stent thrombosis in the early postoperative period after emergency stenting of coronary vessels is 0.95%, with a decrease in EF to 46% and APTT up to 29 sec, the risk increases to 2, 3%, and with a pronounced drop in EF to 40% and APTT up to 25 sec - up to3.3%.

Table 1 - Results of the correlation analysis of the risk of thrombosis in the coronary stent and echocardiography data (the values of the Gamma (G) coefficient are presented at p <0.05).

  Index Coronary stent thrombosis (n = 59)
 Asynergy of the LV lower wall  NS
 Enlargement of the chambers of the heart
 0.64
 Mitral regurgitation
 0.30
 LV contractile function
 0.59
 Atherosclerosis BCA  NS
 Intimal seal
 0.63
 Ascending aortic diameter  NS
 Intima-media complex  NS
 LV end systolic dimension  NS
 Ejection fraction
 0.23




Conclusion

Echocardiography is less informative in terms of predicting the risk of coronary stent thrombosis in the early postoperative period than laboratory parameters. The developed model for predicting the likelihood of coronary stent thrombosis in the early postoperative period with a prediction accuracy of 98.7% can be recommended for use in clinical practice.

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