Dataset Information

Case report of a very late dual coronary stent thrombosis in a patient with coronavirus disease 2019.

ABSTRACT:

Background

Coronavirus disease 2019 (COVID-19) is associated with hypercoagulability and a high rate of thrombosis. Few cases of coronary stent thrombosis associated with COVID-19 have been reported.

Case summary

In this report, we describe the case of a 65-year-old man with a history of coronary artery disease (CAD) who was admitted following an out-of-hospital cardiac arrest related to an ST-segment elevation myocardial infarction revealing a very late dual coronary stent thrombosis of the left anterior descending and posterior descending arteries. Ten days prior to admission, he was diagnosed with COVID-19 pneumonia and treated with dexamethasone, which led to rapid clinical improvement. After resuscitation, coronary angiography revealed an acute thrombotic occlusion in the two previous drug-eluting stents (implanted in 2010 and 2018), with a high thrombus burden. He was successfully treated by percutaneous coronary intervention. The patient did not present any further complications during his hospital stay and was transferred to a cardiac rehabilitation centre.

Discussion

Dual stent thrombosis is an exceptional event highlighting the high procoagulant state promoted by coronavirus 19. This case suggests that strengthening of antithrombotic therapy in CAD patients presenting with COVID-19 should be discussed.

SUBMITTER: Hauguel-Moreau M

PROVIDER: S-EPMC8244633 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundStent thrombosis (ST) is an uncommon but serious complication of stent implantation. This study aimed to explore factors associated with early, late, and very late ST to help guide risk assessment and clinical decision-making on ST.MethodsThe analysis included patients who received stent placement for the index acute coronary syndrome (ACS). Cumulative incidence of ST was assessed at 30 days (early ST), 31-360 days (late ST), 361-720 days (very late ST), and up to 720 days. Cox proportional hazards models were used to assess associations between ST and various factors, including patient characteristics [i.e., age, sex, ACS presentation, history of hypertension, smoking, diabetes, prior myocardial infarction (MI), heart failure, prior ischemic stroke, and cancer], laboratory tests [i.e., positive cardiac biomarker, hemoglobin, platelet count, white blood cell (WBC) count], and treatment [i.e., drug-eluting stent (DES) vs. bare-metal stent (BMS) and anticoagulant with rivaroxaban vs. placebo].ResultsAmong the 8,741 stented patients, 155 ST events (2.25%) occurred by Day 720. The cumulative incidences of early, late, and very late ST were 0.80%, 0.81%, and 0.77%, respectively. After multivariable adjustment, age ≥ 75 [hazard ratio (HR) = 2.13 (95% confidence interval, CI: 1.26-3.60)], a history of prior MI [HR = 1.81 (95% CI: 1.22-2.68)], low hemoglobin level [HR = 2.34 (95% CI: 1.59-3.44)], and high WBC count [HR = 1.58 (95% CI: 1.02-2.46)] were associated with a greater risk of overall ST, whereas DES [HR = 0.56 (95% CI: 0.38-0.83)] and rivaroxaban therapy [HR = 0.63 (95% CI: 0.44-0.88)] were associated with a lower risk of overall ST up to 720 days. Low hemoglobin level and high WBC count were associated with early ST (low hemoglobin: HR = 2.35 [95% CI: 1.34-4.12]; high WBC count: HR = 2.11 [95% CI: 1.17-3.81]). Low hemoglobin level and prior MI were associated with a greater risk of late ST (low hemoglobin: HR = 2.32 [95% CI: 1.26-4.27]; prior MI: HR = 2.98 [95% CI: 1.67-5.31]), whereas DES was associated with a lower risk of late ST [HR = 0.33 (95% CI: 0.16-0.67)]. Age ≥75 years was associated with very late ST.ConclusionThe study identified positive and negative associations with early, late, and very late ST. These variables may be useful in constructing risk assessment models for ST.Clinical trial registrationhttp://www.clinicaltrials.gov, identifier NCT00809965.