Abstract 2565: Predictors For Very Late Stent Thrombosis After Drug-eluting Stent Implantation In Diabetic Patients.
Background: Despite encouraging results with drug-eluting stents (DES) reported in diabetes mellitus (DM) patients (pts) with coronary artery disease, the long-term safety is unknown, because of late-onset stent thrombosis (LST). We investigated the incidence, risk factors and association of antiplatelet treatment (APLT) interruption for the development of LST in DM pts treated with DES during long-term clinical follow-up (FU).
Methods: A total of 610 consecutive DM pts (male 80%, mean age 65 ± 9 years) had been treated with DES (sirolimus 80%, paclitaxel 10%, zotarolimus 2% combination 8%); 133 (22%) were on insulin treatment. Dual APLT treatment for 12 months received 93%, more than 12 months 72% and statin treatment 93% of pts. Clinical FU at least 12 months post-PCI (median 29 months, interquartile range 21 to 40) was obtained in 597/610 (98%) of pts. LST was defined as angiographic documentation of stent occlusion associated with an acute ischemic event, unexplained sudden cardiac death (D) or myocardial infarction (MI) not clearly attributable to another coronary lesion.
Results: The incidence of LST was 2.18% (13 of 597 pts) and 6 additional pts (1%) developed stent thrombosis before 12 months (EST). All pts with LST (median time 19 months, interquartile range 14 to 24) had unexplained sudden cardiac D and 2/6 pts with EST non-fatal MI. Eleven out of 13 pts (85%) were on dual antiplatelet treatment at the time of LST. There was no difference in the incidence of LST between pts on oral antidiabetic medications and insulin treatment (2,1% vs. 2.3%, p:ns). In a multivariate model including clinical and angiographic factors, the only predictor for LST was ejection fraction <40% (OR 0.10, 95% CI 0.03– 0.43, p<0.05).
Conclusion: LST in DM pts occurred in 2.18% after DES implantation; most of these pts were on dual APLT treatment. The only predictor of LST was depressed left ventricular function.