title: Antiplatelet therapy discontinuation and stent thrombosis after sirolimus-eluting stent implantation: five-year outcome of the j-Cypher Registry.
abstract: BACKGROUND
  The influence of antiplatelet therapy discontinuation on the incidence of stent thrombosis, especially very late stent thrombosis, after drug-eluting stent implantation has not been yet fully addressed.
  
  
  METHODS
  Relationship between antiplatelet therapy discontinuation and stent thrombosis up to 5years was evaluated in 12,812 consecutive patients undergoing sirolimus-eluting stents (SES) implantation in the j-Cypher registry. Data on status of antiplatelet therapy during follow-up were collected prospectively.
  
  
  RESULTS
  Median follow-up interval was 1699days (interquartile range, 1184-1928days). Incidences of definite stent thrombosis were 0.34% at 30days, 0.55% at 1year, and 1.6% at 5years. Dual antiplatelet therapy was maintained in 97.4%, 63%, and 43.9% of patients at 30days, 1year, and 5years, respectively. The rates of stent thrombosis in patients who discontinued both thienopyridine and aspirin were significantly higher in the time intervals of 31-365days, 2-3years and 3-4years, and tended to be higher in the time intervals of 1-2years and 4-5years than those in patients who continued both (31-365days: 1.26% versus 0.2%, P<0.001; 1-2years: 0.59% versus 0.15%, P=0.06; 2-3years: 1.35% versus 0.2%, P=0.004; 3-4years: 1.09% versus 0.25%, P=0.0496; 4-5years: 1.35% versus 0.43%, P=0.17). Patients who discontinued either thienopyridine or aspirin only did not have an excess of stent thrombosis in any time intervals.
  
  
  CONCLUSIONS
  In conclusion, discontinuation of both thienopyridine and aspirin, but not discontinuation of thienopyridine or aspirin only, was associated with an increased incidence of late and very late stent thrombosis up to 5years after SES implantation.
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Yano
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Natsuaki
authors.affiliation: Center for Medical Education and Clinical Epidemiology Unit, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Division of Cardiology, Tenri Hospital, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: Division of Cardiology, Chikamori Hospital, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Division of Cardiology, National Cardiovascular Center, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Division of Cardiology, Kawasaki Social Insurance Hospital, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Division of Cardiology, Matsue Red Cross Hospital, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shiode
authors.affiliation: Division of Cardiology, Kanazawa Cardiovascular Hospital, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Namura
authors.affiliation: Division of Cardiology, Ogaki Municipal Hospital, Japan.
authors.forename: Takahito
authors.initials: T
authors.lastname: Sone
authors.affiliation: Division of Cardiology, Gunma Prefecture Cardiovascular Center, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
authors.affiliation: Division of Cardiology, Mie Heart Center, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Nishikawa
authors.affiliation: Division of Cardiology, Tokushima Red Cross Hospital, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hiasa
authors.affiliation: Division of Cardiology, Tsuchiya General Hospital, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Division of Cardiology, Kokura Memorial Hospital, Japan.
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Nobuyoshi
authors.affiliation: Division of Cardiology, Kurashiki Central Hospital, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan. Electronic address: taketaka@kuhp.kyoto-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D003328:Coronary Thrombosis / Q000453:epidemiology / Q000209:etiology*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020123:Sirolimus / Q000494:pharmacology*; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus
keywords: Antiplatelet therapy; Coronary artery disease; Stents; Thrombosis