Vigorous exercise as a triggering mechanism for late stent thrombosis: A description of three cases

Although (very) late coronary stent thrombosis is a rare complication after percutaneous coronary interventions (PCI), its consequences are devastating with a high morbidity and mortality. Previous studies have identified several clinical, procedural and angiographic characteristics that are associated with stent thrombosis but little is known about the underlying mechanisms that induce, provoke or trigger the of stent thrombosis. In the present paper, we describe three patients who suffered from a stent thrombosis immediately after vigorous exercise. Patient 1 suffered a stent thrombosis (ST) after performing an in-hospital bicycle ergometer test, 6 weeks after an acute coronary syndrome. Patient 2 suffered from ST immediately following his first excessive endurance cycling tour, more than 2 years after myocardial infarction. Patient 3 suffered ST while performing vigorous exercise on a bicycle ergometer in a fitness centre. These findings implicate that ST might be triggered by vigorous exercise, especially in untrained patients. Further research after triggering mechanisms of ST is urgently warranted.