Late angiographic stent thrombosis (LAST) events with drug-eluting stents.
OBJECTIVE
We sought to describe the incidence of late angiographic stent thrombosis (LAST) events in an unselected drug-eluting stent (DES) population.


BACKGROUND
Concerns have been raised that LAST may be a potential limitation of DES.


METHODS
We have previously reported the angiographic incidence of early stent thrombosis (1.0%) in this prospective cohort of 2,006 patients treated with either sirolimus-eluting stents (SES) (n = 1,017) or paclitaxel-eluting stents (PES) (n = 989). We continued long-term follow-up to determine the incidence of LAST events, defined as angiographically proven stent thrombosis associated with acute symptoms more than 30 days after DES implantation. All patients had at least 1 year of follow-up, mean duration 1.5 years.


RESULTS
There were eight angiographically confirmed LAST events in seven patients: three with SES (at 2, 25, and 26 months) and five with PES (at 6, 7, 8, 11, and 14.5 months). Three cases were related to complete cessation of antiplatelet therapy, two cases occurred while patients were on aspirin therapy within one month of cessation of clopidogrel, and three cases occurred at a time when patients were apparently clinically stable on aspirin monotherapy. We observed no cases of LAST in patients who were on dual antiplatelet therapy. Two deaths occurred directly as a result of LAST.


CONCLUSIONS
Angiographically proven late stent thrombosis occurs with an incidence of at least 0.35% (95% confidence limits 0.17% to 0.72%) in patients treated with DES. Importantly, it may also occur when patients are stable on antiplatelet monotherapy.
Ong
Andrew T L
AT
Thoraxcenter, Erasmus Medical Center, Dr. Molewaterplein 40, 3015-GD Rotterdam, the Netherlands.
McFadden
Eugène P
EP
Regar
Evelyn
E
de Jaegere
Peter P T
PP
van Domburg
Ron T
RT
Serruys
Patrick W
PW
D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D017239:Paclitaxel / Q000008:administration & dosage; D011859:Radiography; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors
D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus