Predictors for very late stent thrombosis after drug-eluting stent implantation in diabetic patients

Aims: Despite encouraging results with drug-eluting stents (DES) reported in diabetic patients, the longterm safety is unknown because of very late stent thrombosis (VLST). We investigated the incidence, risk factors and clinical manifestations of VLST in diabetic patients treated with DES, during long-term clinical follow-up. Methods and results: A total of 610 consecutive diabetic patients underwent PCI with DES. Dual antiplatelet treatment (APLT) for 12 months received 93%, more than 12 months 72% and statin treatment 93% of patients. Clinical follow-up of at least 12 months post DES implantation was obtained in 597/610 (98%) patients. The incidence of VLST was 1.8%, and 1.7% of patients developed stent thrombosis (ST) up to 12 months. All patients with VLST presented with sudden cardiac death and 82% were on dual APLT at the time of the event. In a multivariate model the only predictor for VLST (HR: 20.58, 95% CI 5.17-81.90, p<0.001) and overall ST (HR: 4.38, 95% CI 1.73-11.10, p=0.002) was ejection fraction < 40%. Conclusions: The incidence of ST in diabetic patients undergoing PCI with DES and receiving dual APLT is low at long-term clinical follow-up. The only predictor for VLST and overall ST was depressed left ventricular systolic function.