OBJECTIVE: Stent thrombosis (ST) is a common phenomenon in acute coronary syndromes (ACS) when compared to stable coronary artery disease. This study analyzed the patient- and operator-related risk factors of ST in ACS. METHODS: Coronary angiograms of 1738 consecutive ACS patients admitted in a large tertiary center between year 2014 and 2016 were analyzed retrospectively for the presence of ST. The paired angiograms [ST in ACS during and after percutaneous coronary intervention (PCI)] of the patients were analyzed by two independent observers, with focus on lesion characteristics and procedure techniques. Clinical and laboratory data were collected. RESULTS: Stent thrombosis was found in 29 (1.6%) ACS patients, with a combination of at least one clinical/laboratory risk factor and one lesion/operator risk factor identified in 28 (96%) out of the 29 ACS patients with ST. The following risk factors for ST were found: Renal insufficiency (OR=4.14, p<0.001, 95% CI=1.73-9.88), type 2 diabetes (OR=2.21, p=0.034, 95% CI=1.06-4.61), excessive alcohol consumption (OR=3.12, p=0.023, 95% CI=1.17-8.33), stent implantation for ST-elevation myocardial infarction (STEMI) (OR=2.28, p=0.029, 95% CI=1.08-4.81), left main (LM) or left anterior descending artery (LAD) as culprit lesion (OR=2.80, p=0.010, CI 95%=1.27-5.95), and absence of antiplatelet therapy prior to ST (OR=3.58, p=0.002, 95% CI=1.60-7.96). The following lesion/operator possible risk factors were identified: Bifurcation lesion (n=7; 24%), heavy coronary calcifications (n=13; 44%), in-stent restenosis with secondary plate rupture (n=6, 20%), inappropriate stent size selection (n=6, 20%), and errors in periprocedural drug administration (n=4, 14%). CONCLUSION: ST occurred in 1/62 ACS patients after PCI. A combination of clinical/laboratory and lesion/operator risk factors were present in almost all ACS patients with ST. This finding may support the search for strictly individualized strategies for the treatment of ACS patients with ST after PCI.

• MeSH
• akutní koronární syndrom chirurgie   MeSH
• koronární angioplastika * MeSH
• lidé MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• stenty * MeSH
• trombóza epidemiologie   etiologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

A higher rate of bioresorbable vascular scaffold (BVS) thrombosis has been observed after device implantation compared to implantation of permanent metallic stents in recently published studies. The mechanism of BVS thrombosis is currently under debate. To assess whether the immune-inflammatory response after BVS implantation is a potential trigger of BVS thrombosis. The PRAGUE-19 study was an academic study that enrolled consecutive patients with ST-segment elevation myocardial infarction (STEMI) with the intention to implant a BVS. A laboratory sub-study included 49 patients with an implanted BVS (of which 38 underwent the complete 2-year follow-up) and 52 patients having an implanted permanent metallic stent as the control group (of which 30 underwent the complete 2-year follow-up). Samples for inflammatory markers [high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α)] were taken before BVS or stent implantation, on days 1 and 2 after device implantation and at 1 month and 2 years for a clinical control. The primary combined clinical endpoint of the sub-study (death, reinfarction or target vessel revascularization) occurred in 4.08% of the BVS group and 7.69% of the control group (p = 0.442) during the 2-year follow-up period, with overall mortality of 2.04% in the BVS group and 1.92% in the control group (p = 0.966). Definite BVS thrombosis occurred in one patient in the subacute phase; there was no late or very late thrombosis. Two definite stent thromboses were observed in the control group: one in the subacute phase and the other in the late phase. Baseline inflammatory marker levels did not differ between the groups. Lower levels of IL-6 and hs-CRP were observed in the BVS group compared to the control group (12.02 ± 5.94 vs. 15.21 ± 5.33 pg/ml; p < 0.01; 3952.9 ± 1704.75 ng/ml vs. 4507.49 ± 1190.01 ng/ml; p = 0.037, respectively) on days 1 and 2 (12.01 ± 6.31 vs. 13.85 ± 6.01 pg/ml; p = 0.089; 4447.92 ± 1325.31 ng/ml vs. 4637.03 ± 1290.99 ng/ml; p = 0.255, respectively). No differences in IL-6 or hs-CRP were observed after 1 month or 2 years in the clinical control. Levels of TNF-α did not differ between the groups in the early period after BVS or metallic stent implantation, nor during follow-up. The immune-inflammatory response is lower during the early phase after BVS implantation compared to that after metallic stent implantation, but the responses did not differ in the long term.

• Klíčová slova
• Bioresorbable vascular scaffold, Immune–inflammatory reaction, Myocardial infarction, Percutaneous coronary intervention, Thrombosis,
• MeSH
• časové faktory MeSH
• cytokiny metabolismus   MeSH
• dospělí MeSH
• everolimus farmakologie   MeSH
• imunosupresiva farmakologie   MeSH
• infarkt myokardu s elevacemi ST úseků diagnóza   imunologie   chirurgie   MeSH
• koronární angiografie MeSH
• koronární angioplastika přístrojové vybavení   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• přirozená imunita * MeSH
• protézy - design MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stenty uvolňující léky * MeSH
• tkáňové podpůrné struktury * MeSH
• vstřebatelné implantáty * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Názvy látek
• cytokiny MeSH
• everolimus MeSH
• imunosupresiva MeSH

Dual oral antiplatelet therapy, aspirin plus thienopyridine, has permitted a rapid increase in the use of coronary intervention procedures. Clopidogrel is the thienopyridine of choice for dual antiplatelet therapy in patients treated with percutaneous coronary intervention. However, there are two issues with clopidogrel: (1) clopidogrel's antiplatelet activity is delayed because the drug needs to be metabolized into its active form and (2) variability in patient response to clopidogrel has been demonstrated. To overcome these shortcomings of clopidogrel, new more potent inhibitors of P2Y12 receptors, which have a more rapid onset of action have been introduced for clinical evaluation. This article is a nonexhaustive review of the literature and concentrates on prasugrel, a third-generation, oral thienopyridine. The purpose is to summarize the current knowledge about the benefits and risks of prasugrel and to outline the most prudent strategies for the drug's clinical use.

• MeSH
• aplikace orální MeSH
• Aspirin terapeutické užití   MeSH
• balónková koronární angioplastika škodlivé účinky   přístrojové vybavení   MeSH
• hodnocení rizik MeSH
• infarkt myokardu terapie   MeSH
• inhibitory agregace trombocytů aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• klopidogrel MeSH
• kombinovaná farmakoterapie MeSH
• komplikace diabetu terapie   MeSH
• koronární trombóza etiologie   prevence a kontrola   MeSH
• léková rezistence genetika   MeSH
• lidé MeSH
• piperaziny aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• prasugrel hydrochlorid MeSH
• rizikové faktory MeSH
• stenty MeSH
• thiofeny aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• tiklopidin analogy a deriváty   terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• Aspirin MeSH
• inhibitory agregace trombocytů MeSH
• klopidogrel MeSH
• piperaziny MeSH
• prasugrel hydrochlorid MeSH
• thiofeny MeSH
• tiklopidin MeSH

The authors present a fatal case of late thrombosis of paclitaxel-eluting stent implanted in the left main stem occurring 6 months after the procedure and 3 weeks after the cessation of clopidogrel. An autopsy has shown the lack of endothelization of deployed stent.

• MeSH
• balónková koronární angioplastika škodlivé účinky   přístrojové vybavení   MeSH
• endoteliální buňky patologie   MeSH
• fatální výsledek MeSH
• infarkt myokardu diagnostické zobrazování   terapie   MeSH
• inhibitory agregace trombocytů terapeutické užití   MeSH
• kardiovaskulární látky aplikace a dávkování   MeSH
• klopidogrel MeSH
• koronární angiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• paclitaxel aplikace a dávkování   MeSH
• pitva MeSH
• protézy - design MeSH
• stenty uvolňující léky * MeSH
• tiklopidin analogy a deriváty   terapeutické užití   MeSH
• trombóza etiologie   patologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• inhibitory agregace trombocytů MeSH
• kardiovaskulární látky MeSH
• klopidogrel MeSH
• paclitaxel MeSH
• tiklopidin MeSH