Wenaweser P et al. (2008) Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice: 4-year results from a large 2-institutional cohort study. J Am Coll Cardiol 52: 1134–1140

Late stent thrombosis is a serious and well-recognized complication of drug-eluting stent implantation. Wenaweser and colleagues used 4-year follow-up data from 8,146 patients to identify clinical predictors of early versus late confirmed stent thrombosis, and assessed the extent of stent-thrombosis-related mortality in these patients.

This observational study included patients who received either sirolimus-eluting stents (SESs; n = 3,823) or paclitaxel-eluting stents (PESs; n = 4,323) between April 2002 and December 2005 at one of two European hospitals. Stent thrombosis was confirmed in 192 individuals; this outcome occurred early (<30 days) in 48% of patients, late (30–365 days) in 16%, and very late (≥365 days) in 36%. The annual rate of stent thrombosis remained consistent at 0.53% (95% CI 0.44–0.64%) throughout the 4 years after implantation. PESs were associated with a higher incidence of late and very late stent thrombosis than SESs were (P = 0.047), but no difference existed between the two stent types in the incidence of early stent thrombosis. Multivariate analysis showed that diabetes was an independent predictor of early stent thrombosis (hazard ratio [HR] 1.96; 95% CI 1.18–3.28), and that young age (HR 0.97; 95% CI 0.95–0.99), acute coronary syndrome (HR 2.21; 95% CI 1.39–3.51), and PES use (HR 1.67; 95% CI 1.08–2.56) were predictors of late stent thrombosis. Over the 4 year study period, stent-thrombosis-related mortality accounted for just 3.9% of all deaths.