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Antiplatelet therapy discontinuation and the risk of serious cardiovascular events after coronary stenting: observations from the CREDO-Kyoto Registry Cohort-2.

Watanabe H, Morimoto T, Natsuaki M, Furukawa Y, Nakagawa Y, Kadota K, Yamaji K, Ando K, Shizuta S, Shiomi H, Tada T, Tazaki J, Kato Y, Hayano M, Abe M, Tamura T, Shirotani M, Miki S, Matsuda M, Takahashi M, Ishii K, Tanaka M, Aoyama T, Doi O, Hattori R, Kato M, Suwa S, Takizawa A, Takatsu Y, Shinoda E, Eizawa H, Takeda T, Lee JD, Inoko M, Ogawa H, Hamasaki S, Horie M, Nohara R, Kambara H, Fujiwara H, Mitsudo K, Nobuyoshi M, Kita T, Kastrati A, Kimura T, CREDO-Kyoto PCI/CABG registry cohort-2 investigato - PLoS ONE (2015)

Bottom Line: No-APT as compared with dual- or single-APT was also associated with significantly higher risk for spontaneous myocardial infarction (MI) and stroke regardless of the types of stents implanted.Single-APT as compared with dual-APT was not associated with higher risk for serious adverse events, except for the marginally higher risk for ST in the SES stratum.In conclusion, discontinuation of both aspirin and thienopyridines was associated with increased risk for serious cardiovascular events including ST, spontaneous MI and stroke beyond 1-month after coronary stenting.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

ABSTRACT
Relation of antiplatelet therapy (APT) discontinuation with the risk of serious cardiovascular events has not been fully addressed yet. This study is aimed to evaluate the risk of ischemic event after APT discontinuation based on long-term APT status of large cohort. In the CREDO-Kyoto Registry Cohort-2 enrolling 15939 consecutive patients undergoing first coronary revascularization, 10470 patients underwent percutaneous coronary intervention either with bare-metal stents (BMS) only (N=5392) or sirolimus-eluting stents (SES) only (N=5078). Proportions of patients taking dual-APT were 67.3% versus 33.4% at 1-year, and 48.7% versus 24.3% at 5-year in the SES and BMS strata, respectively. We evaluated daily APT status (dual-, single- and no-APT) and linked the adverse events to the APT status just 1-day before the events. No-APT as compared with dual- or single-APT was associated with significantly higher risk for stent thrombosis (ST) beyond 1-month after SES implantation (cumulative incidence rates beyond 1-month: 1.23 versus 0.15/0.29, P<0.001/P<0.001), while higher risk of no-APT for ST was evident only until 6-month after BMS implantation (incidence rates between 1- and 6-month: 8.43 versus 0.71/1.20, P<0.001/P<0.001, and cumulative incidence rates beyond 6-month: 0.31 versus 0.11/0.08, P=0.16/P=0.08). No-APT as compared with dual- or single-APT was also associated with significantly higher risk for spontaneous myocardial infarction (MI) and stroke regardless of the types of stents implanted. Single-APT as compared with dual-APT was not associated with higher risk for serious adverse events, except for the marginally higher risk for ST in the SES stratum. In conclusion, discontinuation of both aspirin and thienopyridines was associated with increased risk for serious cardiovascular events including ST, spontaneous MI and stroke beyond 1-month after coronary stenting.

No MeSH data available.


Related in: MedlinePlus

Study Flow.BMS = bare-metal stents, CABG = coronary artery bypass grafting, CREDO-Kyoto = Coronary REvascularization Demonstrating Outcome study in Kyoto, DES = drug-eluting stent, IQR = interquartile range, PCI = percutaneous coronary intervention, and SES = sirolimus-eluting stents.
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pone.0124314.g001: Study Flow.BMS = bare-metal stents, CABG = coronary artery bypass grafting, CREDO-Kyoto = Coronary REvascularization Demonstrating Outcome study in Kyoto, DES = drug-eluting stent, IQR = interquartile range, PCI = percutaneous coronary intervention, and SES = sirolimus-eluting stents.

Mentions: The Coronary REvascularization Demonstrating Outcome study in Kyoto (CREDO-Kyoto) percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) registry cohort-2 is a physician-initiated non-company sponsored multicenter registry enrolling consecutive patients undergoing first coronary revascularization procedures at 26 centers in Japan from January 2005 to December 2007 (S1 Appendix). The design and patient enrollment of the registry has been described previously [21]. Among 15939 study patients, 10470 patients were included in the current analysis, including 5078 patients treated with SES only and 5392 patients treated with BMS only (Fig 1). We recently reported the long-term clinical outcome of SES as compared with BMS in this registry [22]. In the current analysis, we evaluated the relation between APT discontinuation and serious cardiovascular events in the SES and BMS strata. The recommended APT regimen was aspirin (> = 81mg daily) indefinitely and thienopyridine (200 mg ticlopidine or 75 mg clopidogrel daily) for at least 3 months after SES implantation, and for at least 1 month after BMS implantation.


Antiplatelet therapy discontinuation and the risk of serious cardiovascular events after coronary stenting: observations from the CREDO-Kyoto Registry Cohort-2.

Watanabe H, Morimoto T, Natsuaki M, Furukawa Y, Nakagawa Y, Kadota K, Yamaji K, Ando K, Shizuta S, Shiomi H, Tada T, Tazaki J, Kato Y, Hayano M, Abe M, Tamura T, Shirotani M, Miki S, Matsuda M, Takahashi M, Ishii K, Tanaka M, Aoyama T, Doi O, Hattori R, Kato M, Suwa S, Takizawa A, Takatsu Y, Shinoda E, Eizawa H, Takeda T, Lee JD, Inoko M, Ogawa H, Hamasaki S, Horie M, Nohara R, Kambara H, Fujiwara H, Mitsudo K, Nobuyoshi M, Kita T, Kastrati A, Kimura T, CREDO-Kyoto PCI/CABG registry cohort-2 investigato - PLoS ONE (2015)

Study Flow.BMS = bare-metal stents, CABG = coronary artery bypass grafting, CREDO-Kyoto = Coronary REvascularization Demonstrating Outcome study in Kyoto, DES = drug-eluting stent, IQR = interquartile range, PCI = percutaneous coronary intervention, and SES = sirolimus-eluting stents.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390156&req=5

pone.0124314.g001: Study Flow.BMS = bare-metal stents, CABG = coronary artery bypass grafting, CREDO-Kyoto = Coronary REvascularization Demonstrating Outcome study in Kyoto, DES = drug-eluting stent, IQR = interquartile range, PCI = percutaneous coronary intervention, and SES = sirolimus-eluting stents.
Mentions: The Coronary REvascularization Demonstrating Outcome study in Kyoto (CREDO-Kyoto) percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) registry cohort-2 is a physician-initiated non-company sponsored multicenter registry enrolling consecutive patients undergoing first coronary revascularization procedures at 26 centers in Japan from January 2005 to December 2007 (S1 Appendix). The design and patient enrollment of the registry has been described previously [21]. Among 15939 study patients, 10470 patients were included in the current analysis, including 5078 patients treated with SES only and 5392 patients treated with BMS only (Fig 1). We recently reported the long-term clinical outcome of SES as compared with BMS in this registry [22]. In the current analysis, we evaluated the relation between APT discontinuation and serious cardiovascular events in the SES and BMS strata. The recommended APT regimen was aspirin (> = 81mg daily) indefinitely and thienopyridine (200 mg ticlopidine or 75 mg clopidogrel daily) for at least 3 months after SES implantation, and for at least 1 month after BMS implantation.

Bottom Line: No-APT as compared with dual- or single-APT was also associated with significantly higher risk for spontaneous myocardial infarction (MI) and stroke regardless of the types of stents implanted.Single-APT as compared with dual-APT was not associated with higher risk for serious adverse events, except for the marginally higher risk for ST in the SES stratum.In conclusion, discontinuation of both aspirin and thienopyridines was associated with increased risk for serious cardiovascular events including ST, spontaneous MI and stroke beyond 1-month after coronary stenting.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

ABSTRACT
Relation of antiplatelet therapy (APT) discontinuation with the risk of serious cardiovascular events has not been fully addressed yet. This study is aimed to evaluate the risk of ischemic event after APT discontinuation based on long-term APT status of large cohort. In the CREDO-Kyoto Registry Cohort-2 enrolling 15939 consecutive patients undergoing first coronary revascularization, 10470 patients underwent percutaneous coronary intervention either with bare-metal stents (BMS) only (N=5392) or sirolimus-eluting stents (SES) only (N=5078). Proportions of patients taking dual-APT were 67.3% versus 33.4% at 1-year, and 48.7% versus 24.3% at 5-year in the SES and BMS strata, respectively. We evaluated daily APT status (dual-, single- and no-APT) and linked the adverse events to the APT status just 1-day before the events. No-APT as compared with dual- or single-APT was associated with significantly higher risk for stent thrombosis (ST) beyond 1-month after SES implantation (cumulative incidence rates beyond 1-month: 1.23 versus 0.15/0.29, P<0.001/P<0.001), while higher risk of no-APT for ST was evident only until 6-month after BMS implantation (incidence rates between 1- and 6-month: 8.43 versus 0.71/1.20, P<0.001/P<0.001, and cumulative incidence rates beyond 6-month: 0.31 versus 0.11/0.08, P=0.16/P=0.08). No-APT as compared with dual- or single-APT was also associated with significantly higher risk for spontaneous myocardial infarction (MI) and stroke regardless of the types of stents implanted. Single-APT as compared with dual-APT was not associated with higher risk for serious adverse events, except for the marginally higher risk for ST in the SES stratum. In conclusion, discontinuation of both aspirin and thienopyridines was associated with increased risk for serious cardiovascular events including ST, spontaneous MI and stroke beyond 1-month after coronary stenting.

No MeSH data available.


Related in: MedlinePlus