title: The potential benefits and risks of the use of dual antiplatelet therapy beyond 6 months following sirolimus-eluting stent implantation for low-risk patients.
abstract: BACKGROUND
  The optimal duration of dual antiplatelet therapy (DAT) in patients undergoing intracoronary sirolimus-eluting stent implantation remains controversial.
  
  
  OBJECTIVE
  To evaluate the clinical effects of long duration DAT in patients undergoing intracoronary sirolimus-eluting stent implantation in daily practice. In addition, to attempt to identify the optimal duration of DAT after implantation of a sirolimus-eluting stent.
  
  
  METHODS
  We retrospectively report on 1293 consecutive patients who underwent successful intracoronary sirolimus-eluting stent implantation. We analyzed the cumulative incidence of stent thrombosis, non-fatal myocardial infarction (MI), death from cardiac causes, and the cumulative incidence of bleeding complications.
  
  
  RESULTS
  We compared the study end point in patients who received DAT for <6 months (n=1136) with that for patients who received DAT for >6 months (n=157). The median follow-up period was 1260 ± 462 days. Major bleeding occurred in 35 patients and intracranial hemorrhage in 8. In patients on DAT for >6 months, the incidence of any bleedings, major bleedings, and intracranial hemorrhage was significantly increased. On the other hand, there was no significant difference between the two groups in the risk of the primary end points (stent thrombosis, non-fatal MI, death from cardiac causes, death or MI).
  
  
  CONCLUSIONS
  Prolonged DAT for more than 6 months was not significantly more beneficial than aspirin monotherapy in reducing the risk of the occurrence of acute MI, stent thrombosis, and death, although it was associated with an increase in bleeding complications for low-risk patients.
authors.affiliation: Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan. User128781448@aol.com
authors.forename: Takafumi
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Shinobu
authors.initials: S
authors.lastname: Hosokawa
authors.forename: Tomoko
authors.initials: T
authors.lastname: Minami
authors.forename: Yudai
authors.initials: Y
authors.lastname: Yano
authors.forename: Kohei
authors.initials: K
authors.lastname: Yoneda
authors.forename: Michiko
authors.initials: M
authors.lastname: Mizobe
authors.forename: Naotsugu
authors.initials: N
authors.lastname: Murakami
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tobetto
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Chen
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Keitaro
authors.initials: K
authors.lastname: Mahara
authors.forename: Riyo
authors.initials: R
authors.lastname: Ogura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Miyajima
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Yuba
authors.forename: Takefumi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Koichi
authors.initials: K
authors.lastname: Kishi
authors.forename: Ryuji
authors.initials: R
authors.lastname: Ohtani
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology; D003331:Coronary Vessels; D048909:Diabetes Complications; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus