Author + information
- Antony G. Kaliyadan,
- Henry Siu,
- David Fischman,
- Nicholas Ruggiero II,
- Babu Jasti,
- Paul Walinsky,
- David Ogilby and
- Michael Savage
A serious long-term complication of drug-eluting stents (DES) is the occurrence of very late stent thrombosis (VLST) beyond one year after implantation. While VLST has been observed at least 3 to 5 years following the initial procedure, it remains unknown whether DES thrombosis is a finite phenomenon which abates over time or is a risk that persists indefinitely.
A retrospective chart and angiographic review was performed to identify a series of patients who presented to our institution with acute myocardial infarction (MI) due to “very”, very late stent thrombosis (VVLST), defined as stent thrombosis occurring more than 5 years after DES implantation.
The study group consisted of 6 patients (5 men and 1 woman), aged 32 to 70 years, who had angiographically confirmed definite VVLST. Five of the patients were active smokers and 3 were diabetic. Interval between stent implantation and VVLST ranged from 5.6 to 7.0 years. The DES was sirolimus-eluting in 3 patients and paclitaxel-eluting in 3 patients. None of the patients were taking clopidogrel at the time of VVLST. The interval between clopidogrel discontinuation and VVLST was 1 week in 2 patients, 3-6 months in 2 patients, and greater than 5 years in 2 patients. Only 2 patients were taking chronic aspirin therapy. Therefore, 4 of the 6 patients were on no antiplatelet therapy prior to VVLST. The clinical presentation of VVLST was an acute MI in all patients, with ST segment elevation in 5 of the 6. All patients were treated successfully by emergent repeat percutaneous coronary intervention.
Risk of stent thrombosis persists beyond 5 years after implantation of first generation DES. These sobering findings underscore the need for clinical vigilance in these patients and corroborate current PCI guidelines which recommend continuing at least aspirin indefinitely after DES.
|Age (years)||Gender||Months Between Initial DES and VVLST||Type of DES||DES to treat BMS restenosis||Clinical Presentation of VVLST||Lesion Location||TIMI Flow Grade||Off Aspirin [if yes, #days]||Off Clopidogrel [if yes, #days]||Medication Non-compliance||HTN||DM||HL||BMI (kg/m2)||Smoking Status|
|70||Male||76||SES||Yes||NSTEMI||OM1||0||Yes ||Yes [1,825]||Yes||No||No||Yes||23||Prior|
|32||Male||84||SES||No||STEMI||LAD||0||Yes ||Yes, ||Yes||Yes||Yes||Yes||58||Active|
|61||Male||77||PES||No||STEMI||LAD||0||Yes [1,825]||Yes [1,825]||Yes||Yes||Yes||Yes||23||Active|
|63||Male||67||PES||Yes||STEMI||LCx||0||Yes ||Yes ||No||Yes||Yes||Yes||46||Active|