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European Heart Journal Advance Access originally published online on June 18, 2008
European Heart Journal 2008 29(17):2108-2115; doi:10.1093/eurheartj/ehn270
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Late and very late stent thrombosis following drug-eluting stent implantation in unprotected left main coronary artery: a multicentre registry

Alaide Chieffo1, Seung-Jung Park2, Emanuele Meliga3, Imad Sheiban4, Michael S. Lee5, Azeem Latib1, Young-Hak Kim2, Marco Valgimigli3, Dario Sillano4, Valeria Magni1, Giuseppe Biondi-Zoccai4, Matteo Montorfano1, Flavio Airoldi1,6, Renata Rogacka1, Mauro Carlino1, Iassen Michev1,6, Cheol-Whan Lee2, Myeong-Ki Hong2, Seong-Wook Park2, Claudio Moretti4, Erminio Bonizzoni7, Giuseppe M. Sangiorgi1,6, Jonathan Tobis5, Patrick W. Serruys3 and Antonio Colombo1,6,*

1 San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
2 Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
3 Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
4 San Giovanni Battista Hospital, Turin, Italy
5 University of California, Los Angeles Medical Center, CA, USA
6 EMO Centro Cuore Columbus, Milan, Italy
7 Institute of Medical Statistics and Biometry, University of Milan, Milan, Italy

Received 31 January 2008; revised 17 April 2008; accepted 29 May 2008; online publish-ahead-of-print 18 June 2008.

* Corresponding author: Tel: +39 02 2643 7331, Fax: +39 02 2643 7339, Email: colombo.antonio{at}hsr.it

See page 2064 for the editorial comment on this article (doi:10.1093/eurheartj/ehn342)

Aims: To evaluate the occurrence of late and very late stent thrombosis (ST) following elective drug-eluting stent (DES) implantation in unprotected left main coronary artery (LMCA) stenosis in a large multicentre registry.

Methods and results: All 731 consecutive patients who had sirolimus- or paclitaxel-eluting stent electively implanted in de novo lesions on unprotected LMCA in five centres were included. ST was defined according to Academic Research Consortium definitions. Four (0.5%) patients had a definite ST: three early (two acute and one subacute) and one late ST, no cases of very late definite ST were recorded. All patients survived from the event. Three patients had a probable ST. Therefore, 7/731 (0.95%) patients had a definite or a probable ST and all were on dual antiplatelet therapy at the time of the event. Possible (eight late and 12 very late) ST occurred in 20 (2.7%) patients. At 29.5 ± 13.7 months follow-up, a total of 45 (6.2%) patients had died; 31 (4.2%) of cardiac death. Ninety five (12.9%) patients had a target-vessel and 76 (10.4%) a target-lesion revascularization. Angiographic follow-up was performed in 548 patients (75%): restenosis occurred in 77 (14.1%) patients.

Conclusion: Elective treatment of LMCA stenosis with DES appears safe with a 0.9% incidence of definite and probable ST at 29.5 ± 13.7 months.

Key Words: Stent • Left main coronary artery • Drug-eluting stents • Stent thrombosis


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