Comparison of different interventional treatment strategies for patients with type 4b acute myocardial infarction caused by very late stent thrombosis

To compare different interventional strategies for patients with 4b-AMI because of very late stent thrombosis (VLST) in real world. 316 patients with VLST-4bAMI were enrolled and divided into Re-stent group, drug coated balloon (DCB) group and plain old balloon angioplasty(POBA) group. The MACE was observed at 1 year follow up including cardiac death, recurrent AMI(re-AMI), target lesion revascularization (TLR) and recurrent ST(RST). The Kaplan-Meier survival curves were used to compare the survival of free-MACE events, and the propensity score matching was used for further analysis. 66 MACEs were observed at 1 year follow-up. There was no significant difference in the MACE between the three groups (P > 0.05), but TLR in the POBA group was the highest (P = 0.023). Kaplan-Meier survival analysis showed that there was no significant difference in the survival of 1-year cumulative free-MACE events between the three groups (P > 0.05), the survival of free-TLR in the POBA group was the lowest (P = 0.015). There was no significant difference in the incidence of MACE after propensity score matching. There is no significant difference in prognosis between the three interventional treatment strategies of VLST-4bAMI. DCB did not have less favorable clinical outcomes than Re-stent or POBA.The treatment of VLST-4bAMI is still a major clinical challenge.