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50th Annual Scientific Session of the American College of Cardiology, March 2001, Orlando, Florida
- The German IST-Registry: Need of One Year of Clopidogrel to avoid late/late Stent Thrombosis.
S. Silber (1), C. Brockhoff (2), R. Doerr (3), A Mügge (4), I. Krischke (1) , P. v. Rottkay (1), T. Meinertz (2)
- 1, Dr. Mueller Hospital, Munich
- 2, Univ. of Hamburg
3, CV-Center, Dresden
4, Univ. of Bochum
- J Am Coll Cardiol, 37, 82-A (2001)
In Germany, intracoronary brachytherapy (ICBT) is being widely used after having received the approval for ist clinical application. The usefulness of routine use of ICBT, however, is considerably limited by its risk of late (up to six months) or late/late (after six months) stent thrombosis. Although the administration of clopidogrel (CLOP) for at least three to six months has shown to reduce the incidence of late stent thrombosis after ICBT, the minimum duration for administration of CLOP to avoid late/late stent thrombosis is unknown.
IST is a new German registry: 212 patients (197 with beta, 15 with gamma radiation) underwent ICBT for 228 lesions: 64% in-stent restenosis, 33 % de-novo, and 3 % restenosis without stents. Mean age was 60±9 (36-79) years and LV-EF 57±11 (31-75)%. For de-novo lesions and restenoses without stents, the dose for coronary vessels with a diameter of 2.7-3.35 mm was 14 Gy; for 3.36-4.0 mm 18 Gy. For in-stent restenosis, the corresponding doses were 16 Gy and 20 - 22 Gy. All pats were enforced to take CLOP for 6 months.Results:
A total of 7 patients developed delayed stent thrombosis: Two patients dicontinued CLOP within the six months time frame with stent thrombosis after 4 weeks, (with CLOP discontinued after 2 weeks) and after 5 months (with CLOP discontinued after 4 months). All other 5 pats (4 beta and 1 gamma) were reliably taking CLOP for 6 months with good results at follow-up angiography. Late/late stent thrombosis in these pats occurred at 7 to 8 months.Conclusions:
The German IST-Registry shows that the official recommendation of prescription of CLOP for 3 to 6 months after ICBT is not safe enough. Therefore, the administration of CLOP for at least 1 year is highly recommended to avoid late/late stent thrombosis.
