Acute stent thrombosis in myocardial infarction complicated by cardiogenic shock in the presence of type 2 diabetes mellitus
Background. Acute stent thrombosis is a rare, but lifethreatening complication of coronary stenting. It occurs during percutaneous coronary intervention or within 24 hours after this procedure. The purpose of the study was to find out the causes and analyze the factors that led to acute stent thrombosis in patients with acute coronary syndrome and type 2 diabetes mellitus (DM) in order to avoid such complications. Materials and methods. There were 119 patients with acute STsegment elevation myocardial infarction. They were treated in the cardiology unit of the Municipal NonProfit Enterprise “Lviv Clinical Emergency Hospital”. All patients were treated using coronary angiography and coronary stenting. An ultrastructural study of venous blood platelets was performed using electron microscopy. Results. Patients with type 2 DM have a higher cardiovascular risk of cardiovascular complications associated with endothelial dysfunction and risk of hypercoagulation and, as a consequence, a tendency towards vasoconstriction, inflammatory reactions, and hemostatiс disorders. In these patients, there is an increased platelet adhesion and an increased concentration of tissue plasminogen activator. During express necropsy and perioperative biopsy of myocardium in patients with DM, we identified the dominance of hypercoagulation in myocardial microvessels as a result of the activity of the blood coagulation system in the absence of direct involvement of the platelets, since some of them were calcified and had reduced functional capacity, and therefore, resistance to aspirin was detected. Persons with type 2 DM usually have severe and more generalized coronary sclerosis, which leads to a more severe course of acute coronary syndrome and a more frequent occurrence of stent thrombosis, which makes expedient the additional prescription of rivaroxaban. Conclusions. Given the signs of decreased platelet reactivity, the dominance of activated coagulation system in patients with DM and an increased risk of coronary artery disease, the use of new oral anticoagulants is relevant and deserves further research.
Full Text:PDF (Українська)
Ganiukov VI, Shilov AA, Bokhan NS, Moiseenkov GV, Barbarash L.S. The Causes of Thrombosis in the Coronary Artery Stent. Int J Intervent Cardioangiol. 2012;28:26-30.
Kuchulakanti PK, Chu WW, Torguson R, et al. Correlates and Long-Term Outcomes of Angiographically Proven Stent Trombosis With Sirolimus- and Paclitaxel-Eluting Stents. Circulation. 2006 Feb 28;113(8):1108-13. doi: 10.1161/CIRCULATIONAHA.105.600155.
Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimuseluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet. 2007 Feb 24;369(9562):667-78. doi: 10.1016/S0140-6736(07)60314-6.
Kyyak YH, Barnett OY, Kovalyshyn VI, Kyyak HY. Koreljacii' mizh klinichnoju i klitynnoju kardiologijeju (kliniko-ul'trastrukturni doslidzhennja): monografija [Correlations between clinical and cellular cardiology (clinical and ultrastructural examinations]. Lviv: Kvart; 2012. 160 p. (in Ukrainian).
Sevostyanova S. The choice of antiaggregants for patients with ACS after fibrinolysis: the results of the TREAT study. Medicine review. 2018;2(49):47-50. (in Russian).
Armstrong EJ, Waltenberger J, Rogers JH. Percutaneous Coronary Intervention in Patients With Diabetes: Current Concepts and Future Directions. J Diabetes Sci Technol. 2014 May;8(3):581-9. doi: 10.1177/1932296813517058.
Kukula K, Klopotowski M, Kunicki PK, et al. Platelet aggregation and risk of stent thrombosis or bleeding in interventionally treated diabetic patients with acute coronary syndrome. BMC Cardiovasc Disord. 2016 Dec 8;16(1):252. doi: 10.1186/s12872-016-0433-x.
Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018 Jan 7;39(2):119-177. doi: 10.1093/eurheartj/ehx393.
This work is licensed under a Creative Commons Attribution 4.0 International License.
© "Publishing House "Zaslavsky", 1997-2018