title: Duration of dual antiplatelet therapy and long-term clinical outcome after coronary drug-eluting stent implantation: landmark analyses from the CREDO-Kyoto PCI/CABG Registry Cohort-2.
abstract: BACKGROUND
  Optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been yet fully elucidated.
  
  
  RESULTS
  We assessed the influence of prolonged thienopyridine therapy on clinical outcomes with landmark analysis at 4 and 13 months after DES implantation. Among 6802 patients with at least 1 DES implantation in the CREDO-Kyoto Registry Cohort-2, 6309 patients (on thienopyridine, 5438 patients; off thienopyridine, 871 patients) and 5901 patients (on thienopyridine, 4098 patients; off thienopyridine, 1803 patients) were eligible for the 4- and 13-month landmark analyses, respectively. The majority of patients had stable coronary artery disease (73%) and received sirolimus-eluting stents (93%), and approximately 90% of thienopyridine was ticlopidine. Patients taking thienopyridine had more complex comorbidities and more complex lesion and procedural characteristics as compared with patients not taking thienopyridine. After adjusting for confounders, thienopyridine use was not associated with decreased risk for death/myocardial infarction/stroke (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.89-1.43, P=0.32 in the 4-month landmark analysis; HR, 1.14; 95% CI, 0.90-1.45, P=0.29 in the 13-month landmark analysis, respectively), whereas the risk for GUSTO moderate/severe bleeding tended to be higher in patients taking thienopyridine (HR, 1.51; 95% CI, 1.00-2.23, P=0.049 in the 4-month landmark analysis; HR, 1.44; 95% CI, 0.99-2.09, P=0.057 in the 13-month landmark analysis, respectively).
  
  
  CONCLUSIONS
  Prolonged thienopyridine therapy beyond 4 and 13 months appeared not to be associated with reduction in ischemic events but to be associated with a trend toward increased bleeding. Optimal duration of DAPT after DES implantation might be shorter than the currently recommended 1-year interval.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Tada
authors.forename: Masahiro
authors.initials: M
authors.lastname: Natsuaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Robert A
authors.initials: RA
authors.lastname: Byrne
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Masashi
authors.initials: M
authors.lastname: Iwabuchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shizuta
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.forename: Natsuhiko
authors.initials: N
authors.lastname: Ehara
authors.forename: Tetsu
authors.initials: T
authors.lastname: Mizoguchi
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Mitsuoka
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Inada
authors.forename: Makoto
authors.initials: M
authors.lastname: Araki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaburagi
authors.forename: Ryoji
authors.initials: R
authors.lastname: Taniguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Eizawa
authors.forename: Akira
authors.initials: A
authors.lastname: Nakano
authors.forename: Satoru
authors.initials: S
authors.lastname: Suwa
authors.forename: Akinori
authors.initials: A
authors.lastname: Takizawa
authors.forename: Ryuji
authors.initials: R
authors.lastname: Nohara
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Nobuyoshi
authors.forename: Toru
authors.initials: T
authors.lastname: Kita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011725:Pyridines / Q000008:administration & dosage* / Q000009:adverse effects; D012042:Registries; D020521:Stroke / Q000209:etiology; D013988:Ticlopidine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin