Background
Stent thrombosis (ST) after
drug-eluting stent (DES) implantation remains a life-threatening complication. Recurrent ST (RST) is not a rare phenomenon, potentially contributing to high mortality after the index ST events. However, little evidence is available about the incidence, risk factors, and clinical outcomes of definite RST after DES
thrombosis. Methods and Results From REAL-ST (Retrospective Multicenter Registry of ST After First- and Second- Generation DES Implantation), this study evaluated 595 patients with definite ST (first-generation DES
thrombosis, n=314; second-generation DES
thrombosis, n=281). During a median follow-up of 31 months, we identified 32 patients with definite RST after first-generation DES
thrombosis (n=18) and second-generation DES
thrombosis (n=15). Cumulative incidence of RST was 4.5% and 6.0% at 1 and 5 years, respectively, which did not significantly differ between first-generation DES
thrombosis and second-generation DES
thrombosis. Independent predictors of definite RST were early ST (hazard ratio [HR], 2.38; 95% CI, 1.06-5.35 [P=0.035]) and multivessel ST (HR, 3.47; 95% CI, 1.03-11.7 [P=0.044]). Definite RST was associated with a 2.8-fold increased risk of mortality (adjusted HR, 2.78; 95% CI, 1.35-5.73 [P=0.006]). Conclusions Cumulative incidence of definite RST did not significantly differ between first-generation DES
thrombosis and second-generation DES
thrombosis. Early ST and multivessel ST were risk factors of definite RST. Definite RST significantly increased mortality after DES
thrombosis, highlighting the clinical importance of preventing RST to improve outcomes of patients with ST. Registration URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000025181.