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

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• 作者：Li Xu ; MD ; Hao Sun ; MD ; Lefeng Wang ; MD ; Kuibao Li ; MD ; Dapeng Zhang ; MD ; Mulei Chen ; MD ; Hongshi Wang ; MD ; Weiming Li ; MD ; Zhuhua Ni ; MD ; Kun Xia ; MD ; Yu Liu ; MD ; Xinchun Yang ; MD ; PhD ; ^{yxc6229@sina.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Drug-eluting stent ; Very late stent thrombosis ; Follow-up ; Anti-platelet therapy
• 刊名：Journal of Cardiology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：66
• 期：6
• 页码：496-501
• 全文大小：383 K

文摘

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.