Late Drug-Eluting Stent Thrombosis Presenting with Out-of-Hospital Cardiac Arrest in a Young Patient with Primary Antiphospholipid Syndrome

Late stent thrombosis is an uncommon but potentially fatal complication following percutaneous coronary intervention. In young patients presenting with recurrent myocardial infarction despite appropriate secondary prevention, underlying prothrombotic disorders should be considered. A 39-year-old man presented with out-of-hospital cardiac arrest nine months after implantation of a 2.75×28 mm drug-eluting stent in the left anterior descending artery for anterior ST-segment elevation myocardial infarction. Coronary angiography demonstrated late thrombotic occlusion of the previously implanted stent with TIMI 0 flow. Successful balloon angioplasty followed by kissing balloon inflation restored TIMI 3 flow in both the left anterior descending artery and the diagonal branch. Because of recurrent myocardial infarction due to late stent thrombosis at a young age, the presence of limited conventional risk factors sufficient to explain the clinical presentation, and no reported history of nonadherence to medical therapy, a systematic laboratory evaluation for thrombophilia and antiphospholipid syndrome was performed. Persistent lupus anticoagulant positivity was demonstrated on repeated testing, whereas anticardiolipin and anti-β2-glycoprotein I antibodies were negative. Following multidisciplinary evaluation by the Departments of Cardiology and Rheumatology, the findings supported a clinical diagnosis of primary antiphospholipid syndrome. Long-term vitamin K antagonist therapy was recommended but declined by the patient. At the four-month follow-up after implantable cardioverter-defibrillator implantation, no recurrent thrombotic events or ICD therapies were observed. Young patients presenting with recurrent myocardial infarction secondary to late stent thrombosis, particularly in the absence of documented interruption of dual antiplatelet therapy, should be considered for systematic evaluation of thrombophilic disorders, including antiphospholipid syndrome.

Keywords: Antiphospholipid syndrome, cardiac arrest, drug-eluting stent, late stent thrombosis, young myocardial infarction.