Association of inflammatory activation with acute stent thrombosis

Abstract Background Acute stent thrombosis (ST) is a rare but deleterious event. Acute infection and inflammation may lead to activation of the coagulation system and of platelets. Coronary angiography with stent implantation is often deferred because of increased inflammatory markers. Purpose The aim of this study was to investigate whether an acute inflammatory state is associated with increased risk of early stent thrombosis. Methods Within a prospective single-center registry, the association between pre-procedural acute inflammatory activation, defined as C-reactive protein (CRP) plasma levels >5mg/dL or leukocytes >12 G/L, and occurrence of early stent thrombosis within 30 days after PCI was evaluated. Results We included 11327 patients that underwent coronary stenting. 3964 (35%) were treated for acute coronary syndrome (ACS) and 7363 (65%) had chronic coronary artery disease. The number of definite early ST within 30 days was 91 (0.8 %). Leukocyte count and plasma levels of C-reactive protein (CRP) were available in 6880 patients (87 patients with ST). 1715 patients showed signs of an acute inflammatory state as defined by a leukocyte count > 12 G/L or plasma levels of CRP > 5mg/dL. Stent implantation in patients with acute inflammation was associated with significant increased risk for ST (HR 3.01; p<0.0000001) independent of age, gender, kidney function, number and type of stents, presence of multivessel disease, choice of P2Y12 inhibitor and clinical presentation. This was the case in patients with (HR 2.48; p<0.001) and without acute coronary syndromes (HR 3.59; p<0.001). The incidence of ST in patients with ACS with and without signs of inflammation was 2.7% vs. 1.1% (p<0.001) and in patients with chronic coronary artery disease with and without inflammation was 2.3% vs 0.7% (p<0.001) Conclusions An acute inflammatory state as defined by a leukocyte count > 12 G/L or plasma levels of CRP > 5mg/dL at time of stent implantation was associated with a significant increased risk of acute ST. In particular in patients with chronic coronary artery disease acute inflammatory activation should lead to a deferral of elective interventions. In patients with ACS and increased inflammatory parameters, in which acute PCI is mandatory, future studies are needed, whether more intensive therapy could reduce risk of early ST in this particular high-risk cohort.