Late Outcomes after Drug-Eluting Stent Implantation in Real-World Clinical Practice

Background. We report the late outcomes in 411 consecutive patients undergoing drug-eluting stent (DES) implantation by a single operator between 2003-2006. Methods. Prospective registry with continuous follow up. Patients with stable angina (SA) or acute coronary syndrome (ACS) received DES for long lesions, small vessels, chronic total occlusion, bifurcation, aorto-ostial, left main, post atherectomy or saphenous vein graft lesions, multivessel/multilesion single vessel (V) disease, in-stent restenosis (ISR) or diabetes. Results. Age range: 34-86 years. 166 (40.3%) had ACS, 98.3% hypercholesterolemia and 14.6% diabetes. 261 (63.5%) had percutaneous coronary intervention (PCI) to IV and 150 (36.5%) to >1V. 607 V were treated. 259 patients (63%) had multilesion PCI, and 109 (26.5%) IV multilesion PCI. 293 (71.3%) patients had long lesions and 224 had Vs < 2.75mm diameter. 75.5% of lesions were Type B2/C. 1-8 stents were implanted/patient. 822/883 stents were DES. 108 patients received ≥ Istents 2.5 mm diameter and 246 patients received stents ≥ 20mm long. 25 patients developed late complications. ISR occurred in 23, 3.5-38 months after DES implantation. 3 had sudden late DES thrombosis (LST). 1/3 also had ISR. 20/25 required PCI, 1 CABG and 4 medical treatment. Subsequently, 3 of the 20 required further PCI for recurrent ISR and 1 CABG. 9 patients died during 1-5-year follow up. Conclusions. In "real-world" patients at increased risk of ISR after bare-metal stenting (BMS), "off-label" DES implantation has a low incidence of late complications. The most common is ISR which presents later than after BMS. Acute LST is serious but unusual and may be accompanied by ISR.