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


OBJECTIVE
Long-term clinical outcomes after detection of VLST may be poor.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Kim
Ung
U
Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, South Korea.
Kim
Dong-Kie
DK
Kim
Young-Bok
YB
Seol
Sang-Hoon
SH
Yang
Tae-Hyun
TH
Kim
Dae-Kyeong
DK
Kim
Doo-Il
DI
Kim
Dong-Soo
DS
Lee
Sang-Hee
SH
Hong
Geu-Ru
GR
Park
Jong-Seon
JS
Shin
Dong-Gu
DG
Kim
Young-Jo
YJ
Cho
Yoon-Kyung
YK
Kim
Hyung-Seop
HS
Nam
Chang-Wook
CW
Hur
Seung-Ho
SH
Kim
Kwon-Bae
KB
D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors