Predictors for very late stent thrombosis after drug-eluting stent implantation in diabetic patients.
OBJECTIVE
Despite encouraging results with drug-eluting stents (DES) reported in diabetic patients, the long-term safety is unknown because of very late stent thrombosis (VLST). We investigated the incidence, risk factors and clinical manifestations of VLST in diabetic patients treated with DES, during long-term clinical follow-up.


RESULTS
A total of 610 consecutive diabetic patients underwent PCI with DES. Dual antiplatelet treatment (APLT) for 12 months received 93%, more than 12 months 72% and statin treatment 93% of patients. Clinical follow-up of at least 12 months post DES implantation was obtained in 597/610 (98%) patients. The incidence of VLST was 1.8%, and 1.7% of patients developed stent thrombosis (ST) up to 12 months. All patients with VLST presented with sudden cardiac death and 82% were on dual APLT at the time of the event. In a multivariate model the only predictor for VLST (HR: 20.58, 95% CI 5.17-81.90, p < 0.001) and overall ST (HR: 4.38, 95% CI 1.73-11.10, p = 0.002) was ejection fraction < 40%.


CONCLUSIONS
The incidence of ST in diabetic patients undergoing PCI with DES and receiving dual APLT is low at long-term clinical follow-up. The only predictor for VLST and overall ST was depressed left ventricular systolic function.
Voudris
Vassilis
V
Cardiology Dpt, Onassis Cardiac Surgery Center, Athens, Greece. vvoudris@otenet.gr
Kariofillis
Panagiotis
P
Thomopoulou
Sophia
S
Patsilinakos
Sotiris
S
Manginas
Athanasios
A
Spargias
Constantinos
C
Pavlides
Gregory
G
Cokkinos
Dennis V
DV
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D048909:Diabetes Complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013927:Thrombosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors