Correlates and Outcomes of Late and Very Late Drug-Eluting Stent Thrombosis

• Published in: JACC. Cardiovascular interventions Vol. 7; no. 10; pp. 1093 - 1102
• Main Authors: Waksman, Ron, MD, Kirtane, Ajay J., MD, Torguson, Rebecca, MD, Cohen, David J., MD, Ryan, Thomas, MD, Räber, Lorenz, MD, Applegate, Robert, MD, Waxman, Sergio, MD, Gordon, Paul, MD, Kaneshige, Kimberly, BS, Leon, Martin B., MD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2014
• Subjects: Cardiovascular; drug-eluting stent; late stent thrombosis; percutaneous coronary intervention; saphenous vein graft; ST-elevation myocardial infarction; SVG; myocardial infarction; interquartile range; Thrombolysis In Myocardial Infarction; drug-eluting stent(s); dual antiplatelet therapy; percutaneous coronary intervention; acute coronary syndrome; stent thrombosis; STEMI; MI; DAPT; ST; bare-metal stent(s); drug-eluting stent; BMS; IQR; LAD; QCA; late stent thrombosis; ACS; quantitative coronary angiography; DES; left anterior descending; TIMI; PCI
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2014.04.017

Abstract Objectives The aim of this study was to identify clinical, procedural, and angiographic correlates of late/very late drug-eluting stent (DES) thrombosis as well as to determine the clinical outcomes of these events. Background Late/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infrequency of these events, even in large cohort studies. Methods In the DESERT (International Drug-Eluting Stent Event Registry of Thrombosis), a retrospective, case-control registry, 492 cases of late/very late definite DES thrombosis from 21 international sites were matched in a 1:1 fashion with controls without stent thrombosis (ST). Controls were matched according to 2 criteria: same enrolling institution and date of initial DES implantation. Baseline and procedural variables were collected, and clinical follow-up was obtained for patients with ST as long as 1 year after the event. Offline quantitative coronary angiography was performed for a subset of 378 case-control pairs. Results The majority of ST events occurred after 1 year (75%) and continued to occur for as long as 7.3 years. The clinical presentation of late/very late ST events was mainly myocardial infarction (66.7% ST-segment elevation myocardial infarction and 22.0% non–ST-segment elevation myocardial infarction); in-hospital mortality was 3.8%. A minority of patients (30%) with ST were receiving dual-antiplatelet therapy at the time of the event. Independent clinical correlates of late/very late ST were younger age, African-American race, current smoking, multivessel disease, longer stented length, overlapping stents, and percutaneous coronary intervention of vein graft lesions. Independent angiographic correlates for late/very late ST were lesions within the left anterior descending artery or a bypass graft, thrombus, and a larger residual diameter stenosis after the initial DES implantation. Despite the large sample of ST cases, all identified correlates of late/very late ST had weak associations with subsequent ST (all odds ratios <2.5). Conclusions Despite a large sample of ST cases and use of limited matching to maximize the identification of predictive factors associated with late/very late ST, the variables associated with the development of late/very late ST were only weakly predictive of subsequent events. Additionally, a relatively low observed mortality rate of ST in this series may reflect a different pathophysiology of these late/very late events compared with acute/subacute ST. (Drug Eluting Stent Registry of Thrombosis [DESERT]; NCT00812552 ).