Long-term clinical outcomes after angiographically defined very late stent thrombosis of drug-eluting stent.

Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, South Korea.
Clinical Cardiology (Impact Factor: 1.83). 10/2009; 32(9):526-9. DOI:10.1002/clc.20648
Source: PubMed

ABSTRACT The advent of drug-eluting stent (DES) use has raised concerns regarding later occurring stent thrombosis, especially very late stent thrombosis (VLST), and little is known about long-term clinical outcomes after VLST occurrence.
Long-term clinical outcomes after detection of VLST may be poor.
We evaluated 3572 consecutive patients who received DES implantation from May 2004 to July 2007 at 3 hospitals. The primary outcomes were a composite of major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI), target-lesion revascularization (TLR), and target-vessel revascularization (TVR) after VLST occurrence.
We identified 19 patients (0.53%) with angiographically documented stent thrombosis developing over 1 year after DES implantation. The mean time to VLST occurrence was 899 days (899 +/- 353). Discontinuation of antiplatelet drugs was noted in 4 (21%) patients and the average duration of discontinuation was 4 days. Clinical presentations of VLST were mainly MI (17 patients, 89%). Balloon angioplasty was only performed in 12 patients (63%) and stent implantation in 7 patients (37%). Mean follow-up duration from VLST occurrence was 620 days (620+/-256). During clinical follow-up after VLST occurrence, no cardiac deaths or MIs were detected. Target-vessel revascularization was done in 2 (11%) patients and TLR in 1 patient (6%). Major adverse cardiac events occurred in 3 (16%) patients during long-term clinical follow-up.
Clinical presentation of VLST after DES implantation is associated with serious adverse events, such as MI. Long-term follow-up outcomes after VLST occurrence appear unfavorable and more data from larger studies are warranted.

0 0
  • Source
    New England Journal of Medicine 03/2006; 354(5):483-95. · 51.66 Impact Factor
  • Circulation 11/2007; 116(17):1952-65. · 15.20 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: There are limited data on the long-term clinical outcome after an angiographically confirmed (definite) stent thrombosis (ST). Four hundred thirty-one consecutive patients with a definite ST were enrolled in this multicenter registry. The primary end point was the composite of cardiac death and definite recurrent ST. Secondary end points were all-cause death, cardiac death, definite recurrent ST, definite and probable recurrent ST, any myocardial infarction, and any target-vessel revascularization. The primary end point occurred in 111 patients after a median follow-up of 27.1 months. The estimated cumulative event rates at 30 days and 1, 2, and 3 years were 18.0%, 23.6%, 25.2%, and 27.9%, respectively. The cumulative incidence rates of definite recurrent ST, definite or probable recurrent ST, any myocardial infarction, and any target-vessel revascularization were 18.8%, 20.1%, 21.3%, and 32.0%, respectively, at the longest available follow-up. Independent predictors for the primary end point were diabetes mellitus, total stent length, severe calcification, American College of Cardiology/American Heart Association B2-C lesions, TIMI (Thrombolysis In Myocardial Infarction) flow grade <3 after percutaneous coronary intervention, and left ventricular ejection fraction <45%. The implantation of an additional coronary stent during the first ST was also associated with unfavorable outcome. Clinical outcome was not affected by the type of previously implanted stent (drug-eluting or bare-metal stent) or the category of ST (early versus late). The long-term clinical outcome after a first definite ST is unfavorable, with a high mortality and recurrence rate. Diabetes mellitus, left ventricular ejection fraction <45%, long total stent length, complex coronary lesions, TIMI flow grade <3 after percutaneous coronary intervention, and implantation of an additional coronary stent during the emergent percutaneous coronary intervention for the ST were associated with this unfavorable outcome.
    Circulation 02/2009; 119(6):828-34. · 15.20 Impact Factor