Clinical Predictors of In-Hospital Mortality among Patients with Stent Thrombosis Following Primary Percutaneous Coronary Intervention Using Drug-Eluting Stents

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OBJECTIVE: To determine the clinical and procedural predictors of in-hospital mortality among patients presenting with stent thrombosis (ST) following primary percutaneous coronary intervention (PCI) with drug-eluting stents (DES) at a tertiary care cardiovascular hospital, Karachi, Pakistan. STUDY DESIGN: An observational cohort study. Place and Duration of the Study: Department of IVC, National Institute of Cardiovascular Diseases, Karachi, Pakistan, from October 2023 to May 2024. METHODOLOGY: Consecutive adult patients who developed angiographically confirmed ST after primary PCI with DES were enrolled. ST was adjudicated according to the Academic Research Consortium criteria by an independent, blinded committee. Demographic variables, comorbidities, haemodynamic parameters, and procedural characteristics were recorded. The primary outcome was all-cause in-hospital mortality. Univariable analyses identified candidate predictors, which were entered into a multivariable logistic regression model. RESULTS: Of 148 patients (mean age 57.6 ± 9.2 years; 79.7% male), in-hospital mortality was 25.0%. Independently increased odds of death were observed for temporary pacemaker use (adjusted OR 43.0; 95% CI: 3.99-464.02; p = 0.002), intra-procedure slow-flow/ no-reflow (OR 12.5; 95% CI: 2.04-76.10; p = 0.006), advancing age per year (OR 1.145; 95% CI: 1.040-1.261; p = 0.006), and higher heart rate per bpm (OR 1.040; 95% CI: 1.003-1.078; p = 0.033). Each 1 mm Hg increment in systolic blood pressure was associated with a 5% reduction in mortality (OR 0.950; 95% CI: 0.917-0.985; p = 0.005). CONCLUSION: In patients with ST following primary PCI, markers of acute haemodynamic compromise and procedural severity were strongly associated with in-hospital mortality. KEY WORDS: Stent thrombosis, Primary percutaneous coronary intervention (PCI), In-hospital mortality, Risk factors.

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