Abstract 16577: Plateau for Occurrence of Stent-Related Cardiac Events Beyond 3-Years After Implantation of the Sirolimus-Eluting Stent: 6-Year Follow-up of the Evastent Patients.
Objective:Since the widespread introduction of Sirolimus-Eluting Stents (SES) in 2003 concerns have been raised about stent thrombosis (ST), including the possibility of late and very late (VLAST). The frequency of VLAST up to 3 years is documented to be 0.5% to 0.6%/year in previous registries, as in EVASTENT. However, how often do “very” VLAST occur after 3 years?
Methods: We have followed 1731 patients included in the EVASTENT matched cohort registry (diabetic vs non diabetic patients, with or without multiple diseased vessels) 6 years after stent implantation. Patients, their cardiologist, their primary care physician, and/or their local interventional cardiology unit were contacted at 6 years after implantation of one or more SES in the context of the EVASTENT study. Documentation was obtained on the cause of any death and on any hospitalization involving myocardial infarction and/or suspected stent thrombosis. We also recorded any new revascularizations and whether these concerned the target stent or not.
Results: At 6 years information concerning 1560 pts (90% follow-up) was obtained. Since the 3 year follow up 76 (4.8%) patients had died, although only 16 of these could be classified as cardiac deaths. Seven sudden deaths with massive myocardial infarction had occurred in which a possible ST was implicated (ARC definition). Only two definite ST were found in patients with myocardial infarction who survived. Patients continue to require revascularization procedures, but most (70%) do not concern the target lesion. We found that 51% of patients continued to be on Clopidogrel therapy 6 years after receiving a SES.
Conclusions: All cause deaths (cancer, complications of diabetes, etc) continue at a steady rate reflecting the increased age of the population and in particular in the diabetic groups with multiple pathologies. However, cardiac deaths plateau beyond 3 years and “very very late” ST are “very very rare”.
- © 2010 by American Heart Association, Inc.