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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

Incidence Rates for Spontaneous MI in the BMS group.(A) Incidence rates of spontaneous MI in the BMS group in the pre-specified time intervals, and (B) cumulative incidence rates of spontaneous MI in the BMS group. APT = antiplatelet therapy, BMS = bare-metal stents, DAPT = dual-APT, MI = myocardial infarction, SAPT = single-APT, and ST = stent thrombosis.
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pone.0124314.g007: Incidence Rates for Spontaneous MI in the BMS group.(A) Incidence rates of spontaneous MI in the BMS group in the pre-specified time intervals, and (B) cumulative incidence rates of spontaneous MI in the BMS group. APT = antiplatelet therapy, BMS = bare-metal stents, DAPT = dual-APT, MI = myocardial infarction, SAPT = single-APT, and ST = stent thrombosis.

Mentions: No-APT as compared with dual- or single-APT was associated with higher risk for spontaneous MI, while single-APT as compared with dual-APT was not associated with higher risk for spontaneous MI regardless of the timing after stent implantation and regardless of the stent types implanted (Figs 6 and 7). The duration from APT discontinuation to the onset of spontaneous MI in SES strata tended to be shorter in the no-APT group than in the single-APT group, although in BMS strata the duration was significantly shorter in no-APT group (Table 3; S3 Fig)


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)

Incidence Rates for Spontaneous MI in the BMS group.(A) Incidence rates of spontaneous MI in the BMS group in the pre-specified time intervals, and (B) cumulative incidence rates of spontaneous MI in the BMS group. APT = antiplatelet therapy, BMS = bare-metal stents, DAPT = dual-APT, MI = myocardial infarction, SAPT = single-APT, and ST = stent thrombosis.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0124314.g007: Incidence Rates for Spontaneous MI in the BMS group.(A) Incidence rates of spontaneous MI in the BMS group in the pre-specified time intervals, and (B) cumulative incidence rates of spontaneous MI in the BMS group. APT = antiplatelet therapy, BMS = bare-metal stents, DAPT = dual-APT, MI = myocardial infarction, SAPT = single-APT, and ST = stent thrombosis.
Mentions: No-APT as compared with dual- or single-APT was associated with higher risk for spontaneous MI, while single-APT as compared with dual-APT was not associated with higher risk for spontaneous MI regardless of the timing after stent implantation and regardless of the stent types implanted (Figs 6 and 7). The duration from APT discontinuation to the onset of spontaneous MI in SES strata tended to be shorter in the no-APT group than in the single-APT group, although in BMS strata the duration was significantly shorter in no-APT group (Table 3; S3 Fig)

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