Stents in coronary arteries: Acute inflammation triples the risk of thrombosis

2024-01-29 08:20:31

Vienna (OTS) – To treat angina pectoris or heart attacks, coronary stents are implanted in more than 26,000 patients in Austria every year. These are metal vascular supports that can help narrowed vessels remain open for many years. Acute clot formation (thrombosis) is the most feared complication in these procedures. Now a study by MedUni Vienna recently published in the Journal of the American Heart Association (JAHA) shows for the first time that acute inflammation increases the risk of stent thrombosis threefold elevated.

As part of the study, the team led by first author Konstantin Krychtiuk and study leader Walter Speidl (Clinical Department of Cardiology at the University Clinic for Internal Medicine II at MedUni Vienna) analyzed data from 11,327 patients who had received a stent within the past decade. This measure was indicated due to atherosclerotic deposits in the coronary arteries, which had led to narrowing and thus to angina pectoris or heart attack. In addition to bypass surgery, the most common treatment method in such cases is the implantation of coronary stents as part of a cardiac catheter examination. Despite major medical advances, 0.8 to two percent of patients still experience potentially life-threatening stent thrombosis, i.e. an acute closure of the implant due to blood clots, within 30 days. The main result of the analysis is that the risk of this complication is tripled if there is acute inflammation at the time of the cardiac catheter examination. This was determined by increased levels of the inflammatory marker C-reactive protein (CRP) and the number of white blood cells. Blood tests are routinely performed in preparation for a cardiac catheterization.

Pneumonia particularly risky
As the scientific studies showed in detail, the rate of stent thrombosis in patients with low inflammation levels was relatively low at 0.6 to 1.1 percent. However, if there were CRP values of more than 50 mg/l or a leukocyte count greater than 12 G/l, the rate increased almost threefold to 2.1 to 2.8%. In particular, pneumonia and blood poisoning were often associated with stent thrombosis. “It is therefore important that only urgently necessary stents are implanted in the event of acute inflammation, for example in the context of an acute heart attack. Otherwise, the procedure should be postponed until the infection has subsided,” Konstantin Krychtiuk and Walter Speidl summarize the essence of the results. Multicenter studies should confirm the findings in the next step before clinical guidelines are adapted accordingly.

In Austria, more than 26,000 coronary stents are implanted every year to treat angina pectoris or acute heart attacks. “In recent years, the occurrence of stent thrombosis has been significantly reduced thanks to modern stents, improved implantation techniques and very effective medications to inhibit blood platelets,” reports study author Christian Hengstenberg, head of the Clinical Department of Cardiology at the MedUni University Clinic for Internal Medicine II Vienna, from research and clinic. The fact that this complication, which is fatal in 20 percent of cases, still occurs is mainly attributed to stopping platelet inhibitors, i.e. blood-thinning medications, too early.

Publikation: Journal of the American Heart Association (JAHA)
Association of Periprocedural Inflammatory Activation With Increased Risk for Early Coronary Stent Thrombosis;
Konstantin A Krychtiuk, Konstantin Bräu, Stephanie Schauer, Alexander Sator, Lukas Galli, Andreas Baierl, Christian Hengstenberg, Clemens Gangl, Irene M Lang, Christian Roth, Rudolf Berger, Walter S. Speidl;
Doi: 10.1161/JAHA.122.032300