Factors Impacting Stent Thrombosis in Patients With Percutaneous Coronary Intervention and Coronary Stenting: A Systematic Review and Meta-Analysis

Abstract

Stent thrombosis (ST) is a frequently reported complication in cardiac patients with percutaneous coronary intervention (PCI) that adversely impacts their prognostic outcomes. Medical literature reveals several baseline characteristics of PCI patients that may predict their predisposition to ST and its potential complications. Our systematic review and meta-analysis aimed to determine the diagnostic significance of these baseline parameters in terms of determining the risk of ST among adult patients with PCI. We statistically evaluated 18 baseline characteristics of more than 15,500 PCI patients to delineate their stent thrombosis attribution. We included a number of articles focusing on baseline parameters in-stent thrombosis-related PCI scenarios. We explored the articles of interest based on inclusion/exclusion parameters across PubMed, JSTOR, Cochrane library, Google Scholar, and Embase. Medical subject headings (MeSH) words included "stent thrombosis," "percutaneous coronary intervention," and "coronary stenting." We extracted the research articles published between 2005 and 2021 on April 20, 2021. The included studies also focused on procedures and clinical factors concerning their association with PCI-related ST. Our findings ruled out the progression of abnormal left ventricular ejection fraction (LVEF)-related stent thrombosis in PCI patients (odds ratio {OR}: 9.68, 95% CI: 1.88-49.90, p=0.007). We found an insignificant clinical correlation between stent thrombosis and PCI in the setting of acute coronary syndrome (ACS). Our study outcomes further revealed the absence of stent thrombosis in PCI patients with antiplatelet prescription (OR: 32.42, 95% CI: 21.28-49.39). The findings affirmed the absence of ST in PCI patients receiving aspirin therapy (OR: 32.77, 95% CI: 18.73-57.34; OR: 4.59, 95% CI: 1.97-10.73). The majority of the included studies negated the clinical correlation of stent thrombosis with diabetes mellitus in the setting of PCI (OR: 0.49, 95% CI: 0.06-3.78). Our study did not reveal statistically significant results based on stent thrombosis in PCI patients with drug-eluting stents (OR: 2.91, 95% CI: 0.35-24.49). The findings also did not reveal the impact of cardiac biomarker elevation on stent thrombosis in PCI patients (OR: 8.42, 95% CI: 2.54-27.98, p=0.0005). Eight studies revealed a statistically insignificant correlation between myocardial infarction and stent thrombosis in PCI scenarios (OR: 2.69, 95% CI: 0.89-8.11, p=0.08). The clinical correlation between PCI and stent thrombosis/major bleeding in the setting of hypertension also proved statistically insignificant at 0.67 (OR: 1.31, 95% CI: 0.38-4.51, p=0.97). The study findings did not correlate mean body mass index and multivessel coronary artery disease with ST in PCI scenarios (OR: 1.98, 95% CI: 0.02-239.58, p=0.78; OR: 1.09, 95% CI: 0.58-2.04, p=0.80). Only two studies revealed statistically significant results confirming stent thrombosis in PCI patients with a prior history of PCI (OR: 0.49, 95% CI: 0.23-1.06; OR: 0.33, 95% CI: 0.02-5.59; p=0.03). Our findings question the clinical significance of baseline characteristics in terms of predicting stent thrombosis in PCI patients. The results support the requirement of future studies to investigate complex interactions between procedural, medicinal, genetic, and patient-related factors contributing to the development of stent thrombosis in PCI patients.

Keywords: acute coronary syndrome; bare-metal stents; coronary stenting; drug-eluting stents; non-st segment elevation myocardial infarction (nstemi); percutaneous coronary intervention; st-elevation myocardial infarction (stemi); stent thrombosis.

Figure 1. PRISMA flow chart

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. Forest plot (abnormal left ventricular ejection fraction)

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Figure 3. Forest plot (acute coronary syndrome status)

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Figure 4. Forest plot (antiplatelet prescription)

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Figure 5. Forest plot (aspirin prescription)

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Figure 6. Forest plot (diabetes mellitus)

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Figure 7. Forest plot (drug-eluting stent status)

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Figure 8. Forest plot (dyslipidemia)

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Figure 9. Forest plot (elevated cardiac biomarkers)

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Figure 10. Forest plot (heart failure)

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Figure 11. Forest plot (history of MI or CAD)

Image is created by the authors of this study. MI: myocardial infarction; CAD: coronary artery disease

Figure 12. Forest plot (hypertension)

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Figure 13. Forest plot (major bleeding)

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Figure 14. Forest plot (mean body mass index)

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Figure 15. Forest plot (percutaneous coronary intervention for multivessel coronary artery disease)

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Figure 16. Forest plot (prior history of percutaneous coronary intervention)

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Figure 17. Forest plot (renal insufficiency)

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Figure 18. Forest plot (smoking history)

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Figure 19. Forest plot (ST-segment elevation myocardial infarction)

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