Patient Characteristics at Time of Stent Thrombosis According to the Timing of Stent Thrombosis.

<p>Values are expressed as means ± SD, median value with interquartile range, or number (%).</p><p>EST  =  early stent thrombosis, LST  =  late stent thrombosis, VLST  =  very late stent thrombosis, ST  =  stent thrombosis, HDL  =  high-density lipoprotein, LDL  =  low-density lipoprotein, LVEF  =  left ventricular ejection fraction, ACE-I  =  angiotensin-converting enzyme inhibitor, ARB  =  angiotensin receptor blocker, and TVR  =  target vessel revascularization.</p><p>Patient Characteristics at Time of Stent Thrombosis According to the Timing of Stent Thrombosis.</p

Pathologic Findings in the Aspirated Thrombi According to the Timing of Stent Thrombosis.

<p>Values are expressed as number (%).</p><p>EST  =  early stent thrombosis, LST  =  late stent thrombosis, VLST  =  very late stent thrombosis, ST  =  stent thrombosis, and WBC  =  white blood cell.</p><p>Pathologic Findings in the Aspirated Thrombi According to the Timing of Stent Thrombosis.</p

A representative case of very late stent thrombosis with fragments of atherosclerotic plaques retrieved from lesions with peri-stent contrast staining and incomplete stent apposition.

<p><b>A</b>, <b>B</b> pre and post coronary angiography for 3 sirolimus-eluting stents implantation in the right coronary artery. <b>C</b>, very late stent thrombosis occurred at 1317 days after the index procedure. Peri-stent contrast staining (<b>arrows</b>) was found in the proximal and distal bifurcation lesions in the right coronary artery. Radiolucency (<b>arrow head</b>) suggesting the presence of thrombus was found in the distal bifurcation lesion. <b>D</b>, Intravascular ultrasound demonstrated intra-stent thrombus and incomplete stent apposition with positive arterial remodeling (asterisk). <b>E</b>, cholesterol crystals with foamy macrophages were observed in the aspirated thrombus (hematoxylin and eosin stain). <b>F</b>, eosinophils (arrow) were sparsely observed in the aspirated thrombus (1.9% out of total white blood cells) (Luna stain).</p

A representative case of very late stent thrombosis with eosinophilic infiltrates in the aspirated thrombus retrieved from lesions with peri-stent contrast staining and incomplete stent apposition.

<p><b>A</b>, <b>B</b> Pre and post coronary angiography at the index sirolimus-eluting stents implantation (modified T stenting) demonstrated bifurcation lesion at the left anterior descending coronary artery. <b>C</b>, peri-stent contrast staining (<b>arrows</b>) was found by follow up angiography 813 days after the index procedure. <b>D</b>, very late stent thrombosis occurred at 1033 days after the index procedure. <b>E</b>, Intravascular ultrasound demonstrated intra-stent thrombus and incomplete stent apposition with positive arterial remodeling (<b>asterisk</b>). <b>F</b>, The histopathological image of the aspirated thrombus showed inflammatory infiltrate with eosinophils (19.4% out of total white blood cells) (Luna stain).</p

Bubble plots for eosinophil fraction in the aspirated thrombi and days between stent implantation and thrombosis in patients with and without PSS or ISA.

<p>Bubble size shows total white blood cell counts per mm² in the aspirated thrombi. EST  =  early stent thrombosis, LST  =  late stent thrombosis, VLST  =  very late stent thrombosis, PSS  =  peri-stent contrast staining, and ISA  =  incomplete stent apposition.</p

Study flow chart of patients with drug-eluting stent thrombosis who underwent thrombus aspiration with retrieved material sufficient for the histopathologic analysis.

<p>DES  =  drug-eluting stents, EST  =  early stent thrombosis, LST  =  late stent thrombosis, and VLST  =  very late stent thrombosis.</p

Antiplatelet Therapy Discontinuation and the Risk of Serious Cardiovascular Events after Coronary Stenting: Observations from the CREDO-Kyoto Registry Cohort-2

<div><p>Relation of antiplatelet therapy (APT) discontinuation with the risk of serious cardiovascular events has not been fully addressed yet. This study is aimed to evaluate the risk of ischemic event after APT discontinuation based on long-term APT status of large cohort. In the CREDO-Kyoto Registry Cohort-2 enrolling 15939 consecutive patients undergoing first coronary revascularization, 10470 patients underwent percutaneous coronary intervention either with bare-metal stents (BMS) only (N=5392) or sirolimus-eluting stents (SES) only (N=5078). Proportions of patients taking dual-APT were 67.3% versus 33.4% at 1-year, and 48.7% versus 24.3% at 5-year in the SES and BMS strata, respectively. We evaluated daily APT status (dual-, single- and no-APT) and linked the adverse events to the APT status just 1-day before the events. No-APT as compared with dual- or single-APT was associated with significantly higher risk for stent thrombosis (ST) beyond 1-month after SES implantation (cumulative incidence rates beyond 1-month: 1.23 versus 0.15/0.29, P<0.001/P<0.001), while higher risk of no-APT for ST was evident only until 6-month after BMS implantation (incidence rates between 1- and 6-month: 8.43 versus 0.71/1.20, P<0.001/P<0.001, and cumulative incidence rates beyond 6-month: 0.31 versus 0.11/0.08, P=0.16/P=0.08). No-APT as compared with dual- or single-APT was also associated with significantly higher risk for spontaneous myocardial infarction (MI) and stroke regardless of the types of stents implanted. Single-APT as compared with dual-APT was not associated with higher risk for serious adverse events, except for the marginally higher risk for ST in the SES stratum. In conclusion, discontinuation of both aspirin and thienopyridines was associated with increased risk for serious cardiovascular events including ST, spontaneous MI and stroke beyond 1-month after coronary stenting.</p></div

Unadjusted and Adjusted Risk of No-APT and SAPT Relative to DAPT for Serious Adverse Events beyond 1-month after index PCI.

<p>APT = no antiplatelet therapy, BMS = bare-metal stents, CI = confidence interval, DAPT = dual-APT, OR = odds ratio, SAPT = single-APT, and SES = sirolimus-eluting stents.</p><p>Unadjusted and Adjusted Risk of No-APT and SAPT Relative to DAPT for Serious Adverse Events beyond 1-month after index PCI.</p

Incidence Rates for Stroke in the SES group.

<p>(A) Incidence rates of stroke in the SES group in the pre-specified time intervals, and (B) cumulative incidence rates of stroke in the SES group. APT = antiplatelet therapy, DAPT = dual-APT, SAPT = single-APT, SES = sirolimus-eluting stents, and ST = stent thrombosis.</p

Prevalence of Each APT Status during Follow-Up.

<p>Prevalence of each APT status during follow-up in the SES group (A), and in the BMS group (B). APT = antiplatelet therapy, BMS = bare-metal stents, DAPT = dual-APT, PCI = percutaneous coronary intervention, and SES = sirolimus-eluting stents.</p