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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

APT Status during 30 days Before Stent Thrombosis in the SES Group.Numbers on the right side indicate number of days from SES implantation to ST. APT = antiplatelet therapy, DAPT = dual-APT, SAPT = single-APT, SES = sirolimus-eluting stents, and ST = stent thrombosis.
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pone.0124314.g010: APT Status during 30 days Before Stent Thrombosis in the SES Group.Numbers on the right side indicate number of days from SES implantation to ST. APT = antiplatelet therapy, DAPT = dual-APT, SAPT = single-APT, SES = sirolimus-eluting stents, and ST = stent thrombosis.

Mentions: In the current analysis, APT status just 1-day before the event might not be causally related to the event, if APT status had changed a few days before the event. Therefore, we evaluated APT status during 30 days before the event in 73 patients with definite ST in the SES stratum (Fig 10). In 2 patients with dual- or single-APT just 1-day before the event, both aspirin and thienopyridines had been discontinued until 3 days before the event. We could not deny the possibility that these ST events were causally related to no-APT, even if these patients were classified as either dual- or single-APT patients according to APT status just 1-day before the event. However, in the remaining 71 patients, same APT status was maintained until the event for at least 1 week. Therefore, APT status just 1-day before the event seemed to correctly reflect APT status during the week before the event in the vast majority of patients with definite ST of SES.


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)

APT Status during 30 days Before Stent Thrombosis in the SES Group.Numbers on the right side indicate number of days from SES implantation to ST. APT = antiplatelet therapy, DAPT = dual-APT, SAPT = single-APT, 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.g010: APT Status during 30 days Before Stent Thrombosis in the SES Group.Numbers on the right side indicate number of days from SES implantation to ST. APT = antiplatelet therapy, DAPT = dual-APT, SAPT = single-APT, SES = sirolimus-eluting stents, and ST = stent thrombosis.
Mentions: In the current analysis, APT status just 1-day before the event might not be causally related to the event, if APT status had changed a few days before the event. Therefore, we evaluated APT status during 30 days before the event in 73 patients with definite ST in the SES stratum (Fig 10). In 2 patients with dual- or single-APT just 1-day before the event, both aspirin and thienopyridines had been discontinued until 3 days before the event. We could not deny the possibility that these ST events were causally related to no-APT, even if these patients were classified as either dual- or single-APT patients according to APT status just 1-day before the event. However, in the remaining 71 patients, same APT status was maintained until the event for at least 1 week. Therefore, APT status just 1-day before the event seemed to correctly reflect APT status during the week before the event in the vast majority of patients with definite ST of SES.

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