The mortality of late stent thrombosis in the drug-eluting stent era - Still underemphasized - Reply

Late stent thrombosis (LST) is an increasingly recognized complication of drug-eluting stents (DES). Colombo and Corbett (1) in their editorial in JACC summarized the evidence and provided perspective. From the data it could be concluded that LST is not overemphasized as has been suggested, but rather deserves more attention. Although a very uncommon occurrence, LST has a mortality of up to 45% (2). Long-term mandatory dual antiplatelet therapy, although effective in reducing LST, carries its own risks and is not an ideal solution. The advantage of DES over baremetal stents is only in the reduction of restenosis, an important complication but not one carrying a significant risk of death (3). In the absence of a clinical trial powered for mortality, the uncommon complication of late stent thrombosis is of great importance, and may mean that drug-eluting stents are not a better choice than bare-metal stents.