Mariko Yano1, Masahiro Natsuaki1, Takeshi Morimoto2, Yoshihisa Nakagawa3, Kazuya Kawai4, Shunichi Miyazaki5, Toshiya Muramatsu6, Nobuo Shiode7, Masanobu Namura8, Takahito Sone9, Shigeru Oshima10, Hideo Nishikawa11, Yoshikazu Hiasa12, Yasuhiko Hayashi13, Masakiyo Nobuyoshi14, Kazuaki Mitsudo15, Takeshi Kimura16. 1. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan. 2. Center for Medical Education and Clinical Epidemiology Unit, Graduate School of Medicine, Kyoto University, Japan. 3. Division of Cardiology, Tenri Hospital, Japan. 4. Division of Cardiology, Chikamori Hospital, Japan. 5. Division of Cardiology, National Cardiovascular Center, Japan. 6. Division of Cardiology, Kawasaki Social Insurance Hospital, Japan. 7. Division of Cardiology, Matsue Red Cross Hospital, Japan. 8. Division of Cardiology, Kanazawa Cardiovascular Hospital, Japan. 9. Division of Cardiology, Ogaki Municipal Hospital, Japan. 10. Division of Cardiology, Gunma Prefecture Cardiovascular Center, Japan. 11. Division of Cardiology, Mie Heart Center, Japan. 12. Division of Cardiology, Tokushima Red Cross Hospital, Japan. 13. Division of Cardiology, Tsuchiya General Hospital, Japan. 14. Division of Cardiology, Kokura Memorial Hospital, Japan. 15. Division of Cardiology, Kurashiki Central Hospital, Japan. 16. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan. Electronic address: taketaka@kuhp.kyoto-u.ac.jp.
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.
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: Ada C Stefanescu Schmidt; Dean J Kereiakes; Donald E Cutlip; Robert W Yeh; Ralph B D'Agostino; Joseph M Massaro; Wen-Hua Hsieh; Laura Mauri Journal: Circulation Date: 2017-02-22 Impact factor: 29.690