Antiplatelet therapy and long-term clinical outcome after sirolimus-eluting stent implantation: 5-year outcome of the j-Cypher registry.
Due to serious concerns on very late stent thrombosis (VLST), extended use of dual antiplatelet therapy (DAPT) beyond 1 year after DES implantation has become a common clinical practice despite apparent lack of evidence suggesting its efficacy in reducing VLST. The study population consisted of 12812 patients in the j-Cypher registry who were treated with at least one sirolimus-eluting stent (SES). We assessed the relation between duration of thienopyridine therapy and clinical outcomes with a landmark analysis at 1 year after SES implantation. Among 11713 patients without myocardial infarction (MI), stent thrombosis and stroke at 1 year who were eligible for the landmark analysis, 7414 patients (63 %) were maintained on thienopyridine at 1-year landmark point, while 4299 patients (37 %) had discontinued thienopyridine before 1-year landmark point. Patients in the on-thienopyridine group had more complex characteristics than patients in the off-thienopyridine group. Cumulative incidence of and the risk for definite VLST in the on-thienopyridine group relative to the off-thienopyridine group favored prolonged DAPT, but were not significant [0.9 and 1.2 %, P = 0.1, and adjusted HR (95 % CI): 0.71 (0.47-1.06), P = 0.11]. Cumulative incidence of and the risk for a composite of death, MI, or stroke in the on-thienopyridine group relative to the off-thienopyridine group were also not significant [15.3 and 14.3 %, P = 0.15, and adjusted HR (95 % CI): 0.99 (0.89-1.11), P = 0.89]. Prolonged use of thienopyridine beyond 1 year after SES implantation was not associated with significant decrease in the risks for VLST or for serious cardiovascular events including death, MI or stroke.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. taketaka@kuhp.kyoto-u.ac.jp
Takeshi
T
Kimura
Takeshi
T
Morimoto
Yoshihisa
Y
Nakagawa
Kazushige
K
Kadota
Yoichi
Y
Nozaki
Tomohisa
T
Tada
Shunsuke
S
Take
Kinya
K
Shirota
Akira
A
Ito
Hitoshi
H
Nakashima
Hiroshi
H
Fujita
Tomohiro
T
Kawasaki
Tsukasa
T
Inada
Koichi
K
Nakao
Shunichi
S
Miyazaki
Osamu
O
Doi
Takaaki
T
Isshiki
Masakiyo
M
Nobuyoshi
Kazuaki
K
Mitsudo
Kazuaki
K
Mitudo
D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use*; D012042:Registries; D020123:Sirolimus / Q000627:therapeutic use*; D013927:Thrombosis / Q000188:drug therapy*; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D020123:Sirolimus