title: Long-term safety and efficacy of sirolimus-eluting stents versus bare-metal stents in real world clinical practice in Japan.
abstract: Long-term safety and efficacy of drug-eluting stents remains controversial. The CREDO-Kyoto registry cohort-2 is a physician-initiated non-company sponsored multi-center registry enrolling consecutive patients undergoing first coronary revascularization in 26 centers in Japan. We compared 3-year outcome between patients treated with sirolimus-eluting stent (SES) only (5092 patients) and bare-metal stent (BMS) only (5405 patients). SES-use as compared with BMS-use was associated with significantly lower adjusted risk for all-cause death [hazard ratio (HR) [95% confidence interval (CI)] 0.72 (0.59-0.87), P = 0.0007], which was mainly driven by the reduction in non-cardiac death [HR (95% CI) 0.64 (0.48-0.85), P = 0.002]. The risk of cardiac death [HR (95% CI) 0.82 (0.63-1.07), P = 0.15], myocardial infarction [HR (95% CI) 0.73 (0.51-1.03), P = 0.07] and definite stent thrombosis [HR (95% CI) 0.62 (0.35-1.09), P = 0.1] was not different between the two groups. Despite longer duration of thienopyridine administration, SES-use was associated with significantly lower risk for bleeding [HR (95% CI) 0.75 (0.6-0.95), P = 0.02] and similar risk for stroke [HR (95% CI) 1.0 (0.75-1.34), P = 1.0]. The risk for target-lesion revascularization (TLR) was markedly lower in the SES group [HR (95% CI) 0.42 (0.36-0.48), P < 0.0001]. The direction and magnitude of the effect of SES relative to BMS in patients presenting acute myocardial infarction (AMI) were similar to those in patients presenting otherwise. In conclusion, SES-use as compared with BMS-use was associated with marked reduction of TLR without any increases in death, myocardial infarction, stent thrombosis, stroke and bleeding in real world clinical practice regardless of clinical presentation including AMI.
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin, Kawahara-cho, Sakkyo-ku, Kyoto, 606-8507, Japan, taketaka@kuhp.kyoto-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
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: 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: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Tada
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kato
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hayano
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamura
authors.forename: Manabu
authors.initials: M
authors.lastname: Shirotani
authors.forename: Shinji
authors.initials: S
authors.lastname: Miki
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Matsuda
authors.forename: Mamoru
authors.initials: M
authors.lastname: Takahashi
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Ishii
authors.forename: Masaru
authors.initials: M
authors.lastname: Tanaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Doi
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Hattori
authors.forename: Ryozo
authors.initials: R
authors.lastname: Tatami
authors.forename: Satoru
authors.initials: S
authors.lastname: Suwa
authors.forename: Akinori
authors.initials: A
authors.lastname: Takizawa
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Takatsu
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takahashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kato
authors.forename: Teruki
authors.initials: T
authors.lastname: Takeda
authors.forename: Jong-Dae
authors.initials: JD
authors.lastname: Lee
authors.forename: Ryuji
authors.initials: R
authors.lastname: Nohara
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kambara
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