Long‐Term Clinical Outcomes After Angiographically Defined Very Late Stent Thrombosis of Drug‐Eluting Stent

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. Hypothesis Long‐term clinical outcomes after detection of VLST may be poor. Method 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. Copyright © 2009 Wiley Periodicals, Inc.