Late and very late stent thrombosis with drug eluting stents

Late and very late stent thrombosis with drug eluting stents still continue to be our concern. Fresh data from the jCypher registry is available from Kimura T and associates [Very Late Stent Thrombosis and Late Target Lesion Revascularization after Sirolimus-Eluting Stent Implantation: Five-year Outcome of the j-Cypher Registry. Circulation. 2012;125:584-91]. In this group of over twelve thousand and eight hundred patients undergoing sirolimus eluting stent implanation, the one month stent thrombosis was 0.3% while the one year cumulative stent thrombosis rate was 0.6%. Five year cumulative stent thrombosis rate was 1.6%.

Risk factors early stent thrombosis (30 days)

  • Acute coronary syndrome
  • Proximal left anterior descending coronary artery

Risk factors for late stent thrombosis (1 year)

  • Side branch stenting
  • Diabetes mellitus
  • End stage renal disease with or without hemodialysis

Risk factors for very late stent thrombosis (5 years)

  • Current smoking
  • Total stent length more than twenty eight millimeters

Early stent thrombosis was calculated at thirty days, late stent thrombosis at one year and very late stent thrombosis at five years. Late and very late stent thrombosis rates were calculated at 0.26% per year. Target vessel revascularization (TLR) within first year was low at 7.35%. Beyond one year, it continued at a rate of 2.2% per year up to five years.

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