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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

Schematic Illustration for the Actual Method Calculating the Incidence Rate of Events for Each APT status.As an example, this figure illustrates how to calculate the incidence rate of stent thrombosis under dual-APT during the interval of 731–1095 days after index SES implantation. For the calculation of incident rate, the numerator is the number of events in patients on dual-APT just 1-day before the event, and the denominator is the total person-days on dual-APT, which is censored after event and expressed as trapezoidal area in the graph. Incidence rate was presented in 100 person-years units. APT = antiplatelet therapy, DAPT = dual-APT, PCI = percutaneous coronary intervention, SES = sirolimus-eluting stents, and ST = stent thrombosis.
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pone.0124314.g002: Schematic Illustration for the Actual Method Calculating the Incidence Rate of Events for Each APT status.As an example, this figure illustrates how to calculate the incidence rate of stent thrombosis under dual-APT during the interval of 731–1095 days after index SES implantation. For the calculation of incident rate, the numerator is the number of events in patients on dual-APT just 1-day before the event, and the denominator is the total person-days on dual-APT, which is censored after event and expressed as trapezoidal area in the graph. Incidence rate was presented in 100 person-years units. APT = antiplatelet therapy, DAPT = dual-APT, PCI = percutaneous coronary intervention, SES = sirolimus-eluting stents, and ST = stent thrombosis.

Mentions: We coded the APT status on daily basis and classified the daily APT status as dual-APT, aspirin only, thienopyridine only, and no-APT. If a serious cardiovascular event occurred, this event was linked to the APT status just 1-day before the event. We did not choose the APT status on the day of the event, because it could be influenced by the event. Patients who experienced the endpoint events were censored on the day of the events. Observations without information of APT status 1-day before the corresponding event were excluded from the analysis. Dividing the number of events by the number of patients in each APT status throughout the pre-specified time intervals after the index stent implantation (within 30 days, 31–180 days, 181–365 days, 366–730 days, 731–1095 days, 1096–1460 days, 1461–1825 days, 1826–2190 days, and 2195–2555 days), we estimated the incidence rate during those time intervals. We expressed the incidence rate as the number of events per 100 person-years (Fig 2). Cumulative incidence rate was calculated in the interval from the pre-specified landmark points (31-day, 181-day, 366-day, 731-day, 1096-day, 1461-day, 1826-day, and 2195-day) to the end of follow-up (2788-day).


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)

Schematic Illustration for the Actual Method Calculating the Incidence Rate of Events for Each APT status.As an example, this figure illustrates how to calculate the incidence rate of stent thrombosis under dual-APT during the interval of 731–1095 days after index SES implantation. For the calculation of incident rate, the numerator is the number of events in patients on dual-APT just 1-day before the event, and the denominator is the total person-days on dual-APT, which is censored after event and expressed as trapezoidal area in the graph. Incidence rate was presented in 100 person-years units. APT = antiplatelet therapy, DAPT = dual-APT, PCI = percutaneous coronary intervention, SES = sirolimus-eluting stents, and ST = stent thrombosis.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0124314.g002: Schematic Illustration for the Actual Method Calculating the Incidence Rate of Events for Each APT status.As an example, this figure illustrates how to calculate the incidence rate of stent thrombosis under dual-APT during the interval of 731–1095 days after index SES implantation. For the calculation of incident rate, the numerator is the number of events in patients on dual-APT just 1-day before the event, and the denominator is the total person-days on dual-APT, which is censored after event and expressed as trapezoidal area in the graph. Incidence rate was presented in 100 person-years units. APT = antiplatelet therapy, DAPT = dual-APT, PCI = percutaneous coronary intervention, SES = sirolimus-eluting stents, and ST = stent thrombosis.
Mentions: We coded the APT status on daily basis and classified the daily APT status as dual-APT, aspirin only, thienopyridine only, and no-APT. If a serious cardiovascular event occurred, this event was linked to the APT status just 1-day before the event. We did not choose the APT status on the day of the event, because it could be influenced by the event. Patients who experienced the endpoint events were censored on the day of the events. Observations without information of APT status 1-day before the corresponding event were excluded from the analysis. Dividing the number of events by the number of patients in each APT status throughout the pre-specified time intervals after the index stent implantation (within 30 days, 31–180 days, 181–365 days, 366–730 days, 731–1095 days, 1096–1460 days, 1461–1825 days, 1826–2190 days, and 2195–2555 days), we estimated the incidence rate during those time intervals. We expressed the incidence rate as the number of events per 100 person-years (Fig 2). Cumulative incidence rate was calculated in the interval from the pre-specified landmark points (31-day, 181-day, 366-day, 731-day, 1096-day, 1461-day, 1826-day, and 2195-day) to the end of follow-up (2788-day).

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