Abstract 2828: Drug-eluting stent thrombosis. Results from a multicenter registry (ESTROFA study)
Background: Stent thrombosis (ST) is a serious complication of drug eluting stents (DES). The incidence of these events, specially those occurring later, the predictors, treatment and long term clinical outcome are not completely elucidated.
Methods: We have performed a registry involving 14 centers in order to collect detailed data regarding DES thrombosis.
Results: From a total cohort of 10000 patients treated with DES since June 2002, 116 cases presented angiographic evidence of ST (1.16%). The ST were: 12 acute, 58 subacute and 46 late. The incidence of late ST was 0.46% and these events occurred at 12±8 months (1–32 months). The ST rate was 1% for Taxus and 1.35% for Cypher. We compared groups with and without ST yielding the following significant differences: ST cases were younger (59.5±12 vs 62±10 yrs), had more infarction as indication for index procedure (40% vs 10%), less EF (50±11% vs 54±10%), less stent diameter (2.8±0.4 vs 2.9±0.3mm), longer stented vessel (25± 14 vs 21± 11mm) and more frequent LAD stent location (72.4% vs 51%). Premature cessation of antiplatelet therapy was detected in 40 (34.5%). A 14% presented with cardiogenic shock. In 105 (90.5%) TIMI flow was 0-I. Thrombecthomy was done in 58 cases (50%) and a new stent was implanted in 49 (42%), most of them DES (77.5%). Abciximab was infused in 91 (78%). A TIMI III flow was obtained in 106 (91%), TIMI II in 8 and TIMI 0-I in 2. Distal embolization was evident in 4 cases. In hospital 7 patients died (6%), 3 pts. required CABG and 1 pt. PCI. At discharge EF was < 25% in 16 pts (14.5%). In follow up (14 ±11 months) 7 (6.4%) patients died (5 cardiac: 4 sudden, 1 post-CABG), 2 pts underwent CABG, 1 pt a heart transplantation (4 pts are in waiting list with ICD) and 4 pts a new PCI.
Conclusions: ST after DES implantation is observed over an extended period of time after the procedure. DES implantation in LAD in a setting of infarction resulted a strong predictor along with antiplatelet therapy cessation. These cases are more prone to develop cardiogenic shock and mortality despite a high rate of successful flow restoration. The long term clinical outcome is seriously affected by the low residual left ventricular function.