Correlates and outcomes of late and very late drug-eluting stent thrombosis: results from DESERT (International Drug-Eluting Stent Event Registry of Thrombosis)

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. Late/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infre...

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Bibliographic Details
Published in:JACC. Cardiovascular interventions 2014-10, Vol.7 (10), p.1093-1102
Main Authors: Waksman, Ron, Kirtane, Ajay J, Torguson, Rebecca, Cohen, David J, Ryan, Thomas, Räber, Lorenz, Applegate, Robert, Waxman, Sergio, Gordon, Paul, Kaneshige, Kimberly, Leon, Martin B
Format: Article
Language:English
Subjects:
Aged
Coronary Angiography
Coronary Artery Disease - diagnosis
Coronary Artery Disease - mortality
Coronary Artery Disease - therapy
Coronary Thrombosis - diagnosis
Coronary Thrombosis - etiology
Coronary Thrombosis - mortality
Coronary Thrombosis - physiopathology
Drug Therapy, Combination
Drug-Eluting Stents
Female
Hospital Mortality
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - etiology
Myocardial Infarction - mortality
Odds Ratio
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - instrumentation
Percutaneous Coronary Intervention - mortality
Platelet Aggregation Inhibitors - therapeutic use
Prosthesis Design
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
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Summary: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. Late/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infrequency of these events, even in large cohort studies. 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. 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 
ISSN:1876-7605
DOI:10.1016/j.jcin.2014.04.017