[Severe myocardial infarction due to late and very late stent thrombosis after coronary artery stenting with drug-eluting stents].
METHODS
Two men, 59 and 65 years old, both with coronary heart disease, were admitted to hospital with acute ST-segment elevation myocardial infarction. They both had undergone coronary artery stenting with drug-eluting stents 9 months and 3 years before, respectively. After stent implantation combined antiplatelet therapy with acetylsalicylic acid and clopidogrel had been administered for 6 and 18 months, respectively. Clopidogrel had been stopped 10 weeks ago in patient 1 and 18 months ago in patient 2.


METHODS
Cardiac catheterization revealed in both cases the diagnosis of stent thrombosis in the drug-eluting stent.


METHODS
After successful intervention, both patients were relieved of their symptoms. The total creatinkinase reached a maximum of 4150 U/l and 3185 U/l, respectively, representing severe myocardial infarction in both cases.


CONCLUSIONS
Myocardial infarction is common in patients with a history of coronary artery disease. Especially after coronary artery stenting with drug-eluting stents, severe myocardial infarction due to stent thrombosis may occur late after stent implantation and be independent of changes in antiplatelet therapy. These patients and physicians should therefore be fully aware of this risk and of the crucial importance of antiplatelet therapy after coronary artery stenting.
Krausgrill
B
B
Klinik III für Innere Medizin, Herzzentrum, Klinikum der Universität zu Köln. benjamin.krausgrill@uk-koeln.de
Erdmann
E
E
Flesch
M
M
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D006328:Cardiac Catheterization; D000077144:Clopidogrel; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D003402:Creatine Kinase; D013988:Ticlopidine; D001241:Aspirin