[Severe myocardial infarction due to late and very late stent thrombosis after coronary artery stenting with drug-eluting stents].

HISTORY AND ADMISSION FINDINGS: Twomen, 59 and 65 years old, both with coronary heart disease, wereadmitted to hospital with acute ST-segment elevation myocardialinfarction. They both had undergone coronary artery stenting withdrug-eluting stents 9 months and 3 years before, respectively. Afterstent implantation combined antiplatelet therapy with acetylsalicylic acidand clopidogrel had been administered for 6 and 18 months, respectively.Clopidogrel had been stopped 10 weeks ago in patient 1 and 18 monthsago in patient 2. INVESTIGATIONS AND DIAGNOSIS: Cardiaccatheterization revealed in both cases the diagnosis of stent thrombosisin the drug-eluting stent. TREATMENT AND COURSE: After successfulintervention, both patients were relieved of their symptoms. Thetotal creatinkinase reached a maximum of 4150 U/l and 3185U/l, respectively, representing severe myocardial infarctionin both cases. CONCLUSION: Myocardial infarction iscommon in patients with a history of coronary artery disease. Especiallyafter coronary artery stenting with drug-eluting stents, severemyocardial infarction due to stent thrombosis may occur late afterstent implantation and be independent of changes in antiplatelettherapy. These patients and physicians should therefore be fullyaware of this risk and of the crucial importance of antiplatelettherapy after coronary artery stenting.