title: Long-term clinical outcomes after angiographically defined very late stent thrombosis of drug-eluting stent.
abstract: 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.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, South Korea.
authors.forename: Ung
authors.initials: U
authors.lastname: Kim
authors.forename: Dong-Kie
authors.initials: DK
authors.lastname: Kim
authors.forename: Young-Bok
authors.initials: YB
authors.lastname: Kim
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Seol
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yang
authors.forename: Dae-Kyeong
authors.initials: DK
authors.lastname: Kim
authors.forename: Doo-Il
authors.initials: DI
authors.lastname: Kim
authors.forename: Dong-Soo
authors.initials: DS
authors.lastname: Kim
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Lee
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.forename: Jong-Seon
authors.initials: JS
authors.lastname: Park
authors.forename: Dong-Gu
authors.initials: DG
authors.lastname: Shin
authors.forename: Young-Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Yoon-Kyung
authors.initials: YK
authors.lastname: Cho
authors.forename: Hyung-Seop
authors.initials: HS
authors.lastname: Kim
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Kwon-Bae
authors.initials: KB
authors.lastname: Kim
mesh_terms: 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
chemical_list: D010975:Platelet Aggregation Inhibitors