Long-term outcomes following very late stent thrombosis of drug-eluting stent

• Published in: Journal of cardiology 2015-12, Vol.66 (6), p.496-501
• Main Authors: Xu, Li, MD, Sun, Hao, MD, Wang, Lefeng, MD, Li, Kuibao, MD, Zhang, Dapeng, MD, Chen, Mulei, MD, Wang, Hongshi, MD, Li, Weiming, MD, Ni, Zhuhua, MD, Xia, Kun, MD, Liu, Yu, MD, Yang, Xinchun, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-platelet therapy; Cardiovascular; Drug-eluting stent; Drug-Eluting Stents - adverse effects; Female; Follow-up; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Long Term Adverse Effects - etiology; Long Term Adverse Effects - mortality; Male; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Proportional Hazards Models; Thrombosis - etiology; Thrombosis - mortality; Treatment Outcome; Very late stent thrombosis
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2014.11.014

Abstract Background Long-term outcomes of very late stent thrombosis (VLST) after implantation of drug-eluting stents (DES) are still unclear. The aim was to evaluate the long-term outcomes after VLST of DES, and to analyze the related factors of long-term outcomes in these patients. Methods From January 2006 to February 2013, patients with angiographically defined VLST were studied. The clinical characteristics, angiography and interventional data, and anti-platelet therapy protocols were analyzed. The patients were divided into two groups according to the occurrence of major adverse cardiac events (MACE) during follow-up. The clinical and interventional data between the two groups were compared. Results Sixty-two patients were enrolled consisting of 55 males and 7 females with an average age of 58.6 ± 10.2 (41–82) years. The mean time from first implantation of DES to occurrence of VLST was 38.7 ± 18.1 (12.5–84) months. One patient died in hospital. Sixty-one patients survived to discharge, and MACE occurred in 17 patients after a median follow-up of 32.1 ± 19.1 (median: 44, range 5–88) months. The total MACE rate was 29.0% (18/62), and Kaplan–Meier survival analysis showed the estimated MACE-free survival was 45.1%. The rate of implantation of an additional first-generation DES during the first VLST in the group with events was higher (44.4% vs.11.4%, respectively, p = 0.007). The percentage of continuous dual antiplatelet therapy (DAPT) at the longest available follow-up was higher in the event-free group (27.8% vs. 75.0%, respectively, p = 0.001). Multivariable Cox regression analysis revealed that the only independent predictors for freedom of MACE during long-term follow-up was continuous DAPT at the longest available follow-up [hazard ratio (HR) = 0.30, 95% CI: 0.09–0.97, p = 0.04]. Conclusions Long-term outcomes after VLST were unfavorable. Implantation of an additional first-generation DES might be avoided, and DAPT should be continued.