TCT-665 Profile and Outcome of Very Late Bare Metal Stent Thrombosis Treated With Percutaneous Coronary Intervention

Abstract

Background: Very late stent thrombosis (VLST) after bare-metal stent (BMS) implantation is a rare complication. There is emerging evidence suggesting that in-stent neoatherosclerosis may play a role, but data on clinical characteristics and prognosis of patients (p) are limited. The aim of this study was to evaluate the profile and outcome of VLST after BMS implantation treated with percutaneous coronary intervention (PCI). Methods: From January 2006 to May 2012 a total of 9,582 PCI were performed at our center. During this period we identified and retrospectively analyzed 30 consecutive p with angiographically confirmed VLST related to BMS. Minimum follow-up period of 1 year and 2 years was available in 25/30 and 23/30 p, respectively. Results: Mean age of p was 60 13 years, 93% were male, 53% active smokers, 20% diabetics, 77% had hyperlipidemia and 67% hypertension. Clinical presentation of VLST after BMS was ST-segment elevation myocardial infarction (STEMI) in 27 cases, and 3 p (10%) had non-STEMI. Right coronary artery was the most common location of VLST (57%). Median period from BMS implantation to VLST was 7.9 years (interquartile range, 6.0-9.9 years) and most of the p (70%) were receiving oral antiplatelet therapy at the time of VLST (67% aspirin alone, 3% dual antiplatelet). All p with VLST after BMS underwent successful PCI. Effective thrombus aspiration was achieved in 67% of p and a new stent was deployed in 83% of p (14 DES, 11 BMS). A significant deterioration of LVEF occurred in p with VLST related to BMS (64 6% to 50 9%; p 0.001). Major adverse cardiac events (cardiovascular death or myocardial infarction) rates were 7%, 20%, and 39% at 30 days, 1-year and 2-year follow-up, respectively. During the 2-year follow-up period 3 p died and 6 p had a non-fatal myocardial infarction (recurrent stent thrombosis in 3 p and myocardial infarction not related to prior VLST in 3 p). Conclusions: VLST after BMS implantation is an uncommon phenomenon, mainly presented as STEMI, and its treatment with a new PCI is feasible and effective. Nevertheless new major adverse cardiac events may occur in this group of p at shortand mid-term follow-up, related to both prior VLST and coronary disease progression.