Failure of drug eluting stents presented as definite stent thrombosis.
BACKGROUND
Stent thrombosis (ST) risk may persist long after a successful drug eluting stents (DES) implantation.


OBJECTIVE
We evaluated the incidence, timing, and clinical outcomes of patients with early (< or =30 days), late (>30-365 days), and very late (>365 days) angiographically proven ST related to DES.


METHODS
Between 2004 and 2009, 4,396 patients underwent percutaneous coronary interventions (PCI) with DES implantations. This 5-year follow-up study included 38 patients (mean age 60 +/- 12 years; 76% males) who were readmitted with confirmed ST diagnoses. Clopidogrel therapy was prescribed for 3-12 months. Clinical follow-ups were conducted at 1 and 6 months following ST events.


RESULTS
The overall ST rate was 0.9% (38/4,396); the late ST rate was 0.7%. There were four (11%) early and 34 (89%) late events; the time interval to thrombosis was 21 +/- 14 months (range 0.13-60 months). Two patients had stent fractures associated with ST, 37% had diabetes, and 68% presented with ST-elevation myocardial infarctions (MI). One third was treated with clopidogrel at the ST event. Three patients (8%) had recurrent late ST events and two died within 1 month after the ST event (5%). At 6 months, we observed a 26% major adverse cardiac event rate, and the overall cardiac mortality rate was 8%.


CONCLUSIONS
In our series, ST occurred infrequently (0.9%), mostly between 1 and 3 years after the period recommended for dual anti-platelet pharmacotherapy, and it is associated with substantial clinical consequences.
Vaknin-Assa
Hana
H
Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
Assali
Abid
A
Lev
Eli I
EI
Ukabi
Shimrit
S
Tamir
Bental
B
Kornowski
Ran
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D017211:Treatment Failure
D010975:Platelet Aggregation Inhibitors