Table 1.
Summary of Cases of Stent Thrombosis Presented During the COVID-19 Pandemic
| Case 1 | Case 2 | Case 3 | Case 4 | |
|---|---|---|---|---|
| Age, yrs | 49 | 71 | 86 | 85 |
| Sex | Male | Male | Male | Male |
| COVID-19 status | IgG + | Suspicion | PCR + | IgM + |
| COVID-19 presentation | Cough, bilateral ground-glass infiltrates | Cough, fever, bilateral ground-glass infiltrates | Asymptomatic, bilateral ground-glass infiltrates | Asymptomatic, bilateral ground-glass infiltrates. |
| COVID19 treatment | No | No | Hydroxychloroquine Acetylcysteine |
Hydroxychloroquine Azithromycin Lopinavir-ritonavir Ceftriaxone |
| Presentation | STEMI | NSTEMI | STEMI | STEMI |
| Physical examination | Rales up to ½ lung fields | Normal | Normal | Peripheral edema |
| Heart rate (beats/min) | 110 | 53 | 75 | 80 |
| Blood pressure (mm Hg) | 150/86 | 150/85 | 160/80 | 110/60 |
| So2 (%) | 90 | 96 | 95 | 95 |
| Temperature (ºC) | 36.5 | 37.5 | 36 | 35.6 |
| Vessel responsible | Proximal circumflex – OM (90% stenosis) | Mid-RCA (occluded) | Proximal LAD (occluded) | Proximal LAD (occluded) |
| Stent thrombosed | DES ×2 (Ultimaster 3 × 15 mm) | BMS (Driver 3.5 × 18 mm) | DES (Cypher 3 × 18 mm) | DES (Synergy 3.5 × 32 mm) |
| Timing | Acute (30 min) | Very late (13 yrs) | Very late (2 yrs) | Very late (4 yrs) |
| APT before admission | None | ASA | ASA | ASA |
| APT during PCI | ASA + clopidogrel | ASA+ clopidogrel | ASA + clopidogrel | ASA+ prasugrel |
| Anticoagulation during PCI | UFH 8,000 IU | UFH 5,000 IU | UFH 8,000 IU | UFH 7,000 IU |
| Vascular approach | Right radial | Left radial | Left radial | Left radial |
| PCI technique | GPI BA OCT guidance |
Thrombectomy DES (Synergy 4 × 28 mm) GPI |
DES (Ultimaster 3 × 15 mm) | Thrombectomy BA IVUS guidance |
| APT discharge | ASA + ticagrelor | ASA+ ticagrelor | ASA + clopidogrel | ASA + clopidogrel |
| LVEF (%) at discharge | 45% | 55% | 45% | 30% |
| Risk factors for stent thrombosis | ||||
| Patient | DM LVD ACS |
CKD ACS |
Age DM LVD CKD ACS PAD |
Age LVD ACS |
| Lesion | Bifurcation | No | No | Ostial lesion |
| Procedural | Primary PCI Multivessel PCI Malapposition Underexpansion Dissection |
No | First-generation DES Overlapped stents |
Long stent |
ACS = acute coronary syndrome; APT = antiplatelet therapy; ASA = acetyl salicylic acid; BA = balloon angioplasty; BMS = bare metal stent; CKD = chronic kidney disease; COVID-19 = coronavirus disease-2019; DES = drug-eluting stent; DM = diabetes mellitus; GPI = glycoprotein IIb-IIIa inhibitor; IU = international units; IVUS = intravascular ultrasound; NSTEMI = non–ST-segment elevation myocardial infarction; OCT = optical coherence tomography; OM = obtuse marginal branch; RCA = right coronary artery; LAD = left anterior descending; LVEF = left ventricular ejection fraction; LVD = left ventricular dysfunction; PAD = peripheral artery disease; PCI = percutaneous coronary intervention; So2 = oxygen saturation; STEMI = ST-segment elevation myocardial infarction; UFH = unfractionated heparin.