title: "Very" very late stent thrombosis: acute myocardial infarction from drug-eluting stent thrombosis more than 5 years after implantation.
abstract: A serious long-term complication of drug-eluting stent (DES) implantation is the occurrence of very late stent thrombosis (VLST) beyond 1 year after implantation. While VLST has been observed as late as 3 to 5 years following the initial procedure, it remains unknown whether DES thrombosis is a finite phenomenon that abates over time or is a risk that persists indefinitely. We identified a series of patients who presented with acute myocardial infarction (MI) due to "very" very late stent thrombosis (VVLST), defined as occurring more than 5 years after DES implantation. The study group consisted of 7 patients (6 men and 1 woman), ages 32 to 70 years, who had angiographically confirmed definite VVLST. Six patients were active smokers and 4 were diabetic. The interval between stent implantation and VVLST ranged from 5.6 to 7.1 years. The DES was sirolimus-eluting in 4 patients and paclitaxel-eluting in 3 patients. None of the patients were taking clopidogrel and only 2 patients were taking aspirin at the time of VVLST. Therefore, 5 of the 7 patients were not on any antiplatelet therapy prior to VVLST. The clinical presentation of VVLST was an acute MI in all patients, with ST-segment elevation in 6 of the 7 patients. Six patients were treated successfully by emergent repeat percutaneous coronary intervention and 1 patient who was postoperative from neurosurgery was managed medically. In conclusion, the risk of stent thrombosis persists even beyond 5 years after first-generation DES implantation. These sobering findings underscore the importance of long-term clinical vigilance in these patients and reinforce current PCI guidelines, which recommend continuing at least aspirin indefinitely after DES.
authors.affiliation: Jefferson Heart Institute, 925 Chestnut Street, Mezzanine, Philadelphia, PA 19107 USA. michael.savage@jefferson.edu.
authors.forename: Antony
authors.initials: A
authors.lastname: Kaliyadan
authors.forename: Henry
authors.initials: H
authors.lastname: Siu
authors.forename: David L
authors.initials: DL
authors.lastname: Fischman
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Ruggiero
authors.forename: Babu
authors.initials: B
authors.lastname: Jasti
authors.forename: Paul
authors.initials: P
authors.lastname: Walinsky
authors.forename: J David
authors.initials: JD
authors.lastname: Ogilby
authors.forename: Michael P
authors.initials: MP
authors.lastname: Savage
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D017239:Paclitaxel; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus; D013927:Thrombosis / Q000150:complications* / Q000517:prevention & control; D013997:Time Factors
chemical_list: D017239:Paclitaxel; D001241:Aspirin; D020123:Sirolimus