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Very late stent thrombosis following drug-eluting stent (DES) implantation can be predicted by angiographic clues, according to an ADAPT-DES sub-study published online in Catheterization and Cardiovascular Interventions.

As was the case with the presence of thrombus (HR 2.25, 95% CI 1.40-3.59), complex lesions -- those of type C on the American College of Cardiology/American Heart Association scale -- were associated with stent thrombosis at 2 years following a propensity-matched analysis (HR 1.97, 95% CI 1.19-3.26).

"Anatomically complex lesions and the presence of thrombus are strong predictors of 2-year stent thrombosis in the DES era," , of New York-Presbyterian Hospital/Columbia University Medical Center in New York, and colleagues concluded.

These strong associations are "consistent with previous reports that identified thrombus, lesion complexity, and implanted stent length as predictors of stent thrombosis" and highlight "the central role of baseline angiographic assessment in risk prediction," they added.

The ADAPT-DES study included 8,582 patients who underwent successful percutaneous coronary intervention (PCI) with mostly second-generation DES.

By 2 years, 1.1% of the participants had definite or probable stent thrombosis, more than four-fifths of which had target lesion-related stent thrombosis.

Second-generation DES mark an improvement in stent thrombosis rates over their first-generation predecessors for ST-elevation myocardial infarction (STEMI) patients.

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