title: Antiplatelet therapy discontinuation and the risk of serious cardiovascular events after coronary stenting: observations from the CREDO-Kyoto Registry Cohort-2.
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.
authors: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Hirotoshi
authors: H
authors: Watanabe
authors: Division of Genera Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors: Takeshi
authors: T
authors: Morimoto
authors: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Masahiro
authors: M
authors: Natsuaki
authors: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors: Yutaka
authors: Y
authors: Furukawa
authors: Division of Cardiology, Tenri Hospital, Tenri, Japan.
authors: Yoshihisa
authors: Y
authors: Nakagawa
authors: Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors: Kazushige
authors: K
authors: Kadota
authors: Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors: Kyohei
authors: K
authors: Yamaji
authors: Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors: Kenji
authors: K
authors: Ando
authors: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Satoshi
authors: S
authors: Shizuta
authors: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Hiroki
authors: H
authors: Shiomi
authors: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Tomohisa
authors: T
authors: Tada
authors: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Junichi
authors: J
authors: Tazaki
authors: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Yoshihiro
authors: Y
authors: Kato
authors: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Mamoru
authors: M
authors: Hayano
authors: Division of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors: Mitsuru
authors: M
authors: Abe
authors: Division of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
authors: Takashi
authors: T
authors: Tamura
authors: Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan.
authors: Manabu
authors: M
authors: Shirotani
authors: Division of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan.
authors: Shinji
authors: S
authors: Miki
authors: Division of Cardiology, Kishiwada City Hospital, Kishiwada, Japan.
authors: Mitsuo
authors: M
authors: Matsuda
authors: Division of Cardiology, Shimabara Hospital, Kyoto, Japan.
authors: Mamoru
authors: M
authors: Takahashi
authors: Division of Cardiology, Kansai Electric Power Hospital, Osaka, Japan.
authors: Katsuhisa
authors: K
authors: Ishii
authors: Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan.
authors: Masaru
authors: M
authors: Tanaka
authors: Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan.
authors: Takeshi
authors: T
authors: Aoyama
authors: Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.
authors: Osamu
authors: O
authors: Doi
authors: Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan.
authors: Ryuichi
authors: R
authors: Hattori
authors: Division of Cardiology, Maizuru Kyosai Hospital, Maizuru, Japan.
authors: Masayuki
authors: M
authors: Kato
authors: Division of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
authors: Satoru
authors: S
authors: Suwa
authors: Division of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
authors: Akinori
authors: A
authors: Takizawa
authors: Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan.
authors: Yoshiki
authors: Y
authors: Takatsu
authors: Division of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan.
authors: Eiji
authors: E
authors: Shinoda
authors: Division of Cardiology, Nishi-Kobe Medical Center, Kobe, Japan.
authors: Hiroshi
authors: H
authors: Eizawa
authors: Division of Cardiology, Koto Memorial Hospital, Higashioumi, Japan.
authors: Teruki
authors: T
authors: Takeda
authors: Division of Cardiology, University of Fukui Hospital, Fukui, Japan.
authors: Jong-Dae
authors: JD
authors: Lee
authors: Cardiovascular Center, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors: Moriaki
authors: M
authors: Inoko
authors: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Hisao
authors: H
authors: Ogawa
authors: Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan.
authors: Shuichi
authors: S
authors: Hamasaki
authors: Department of Cardiovascular and Respiratory, Shiga University of Medical Science, Otsu, Japan.
authors: Minoru
authors: M
authors: Horie
authors: Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan.
authors: Ryuji
authors: R
authors: Nohara
authors: Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.
authors: Hirofumi
authors: H
authors: Kambara
authors: Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan.
authors: Hisayoshi
authors: H
authors: Fujiwara
authors: Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors: Kazuaki
authors: K
authors: Mitsudo
authors: Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors: Masakiyo
authors: M
authors: Nobuyoshi
authors: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors: Toru
authors: T
authors: Kita
authors: Deutsches Herzzentrum, Munich, Germany.
authors: Adnan
authors: A
authors: Kastrati
authors: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Takeshi
authors: T
authors: Kimura
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001241:Aspirin / Q000627:therapeutic use; D023903:Coronary Restenosis / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012042:Registries; D012306:Risk; D020521:Stroke / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D058924:Thienopyridines / Q000627:therapeutic use; D013927:Thrombosis / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control
chemical_list: D010975:Platelet Aggregation Inhibitors; D058924:Thienopyridines; D001241:Aspirin