Kyohei Yamaji1, Hiroki Shiomi1, Takeshi Morimoto1, Toshiaki Toyota1, Koh Ono1, Yutaka Furukawa1, Yoshihisa Nakagawa1, Kazushige Kadota1, Kenji Ando1, Shinichi Shirai1, Masayuki Kato1, Yoshiki Takatsu1, Osamu Doi1, Hirofumi Kambara1, Satoru Suwa1, Tomoya Onodera1, Hirotoshi Watanabe1, Masahiro Natsuaki1, Takeshi Kimura2. 1. From Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (K.Y., K.A., S. Shirai); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.T., K.O., H.W., T.K.); Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Tenri, Japan (Y.N.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K.K.); Division of Cardiology, Maizuru Kyosai Hospital, Maizuru, Japan (M.K.); Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan (Y.T.); Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (O.D., H.K.); Division of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan (S. Suwa); Division of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan (T.O.); and Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.). 2. From Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (K.Y., K.A., S. Shirai); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (H.S., T.T., K.O., H.W., T.K.); Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Tenri, Japan (Y.N.); Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K.K.); Division of Cardiology, Maizuru Kyosai Hospital, Maizuru, Japan (M.K.); Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan (Y.T.); Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (O.D., H.K.); Division of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan (S. Suwa); Division of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan (T.O.); and Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.). taketaka@kuhp.kyoto-ua.ac.jp.
Abstract
BACKGROUND: Female sex was reported to be associated with lower risk for midterm restenosis and repeat revascularization after bare-metal stent implantation. However, the influence of sex on very long-term outcomes after bare-metal stent implantation has not been yet reported. METHODS AND RESULTS: Among the 9877 patients in the multicenter Coronary Revascularization Demonstrating Outcome study in Kyoto (CREDO-Kyoto) registry cohort-1, bare-metal stent implantation was performed in 5313 patients (men, n=3742 and women, n=1571). Follow-up was completed in 4515 patients (85.0%) at 10 years (duration, 10.3 ± 3.1 [0.0-14.1] years). The cumulative incidence of target-lesion revascularization (TLR) was 27% at 1 year and 34% at 10 years (0.8%/y beyond 1 year). Non-target-lesion revascularization (non-TLR) was the dominant coronary revascularization beyond 1 year (13% at 1 year and 31% at 10 years [2.0%/y beyond 1 year]). Cumulative incidence of stent thrombosis was low (1.2% at 1 year and 1.9% at 10 years). Women were older and had greater prevalence of cardiovascular risk factors than men. The cumulative 10-year incidences of and adjusted risk for TLR were significantly higher in men than in women (36% versus 30%, P<0.001; adjusted hazard ratio, 1.29; 95% confidence interval, 1.15-1.46; P<0.001). The higher risk of men relative to women for TLR was consistent regardless of age (<75 years and ≥ 75 years). Men in comparison with women were also associated with significantly higher adjusted risks for all-cause death, myocardial infarction, stroke, coronary artery bypass grafting, TLR, and non-TLR. CONCLUSIONS: TLR and stent thrombosis continued to occur without attenuation up to 10 years after bare-metal stent implantation. Men in comparison with women were associated with higher adjusted 10-year risks for all-cause death, myocardial infarction, stroke, coronary artery bypass grafting, TLR, and non-TLR.
BACKGROUND: Female sex was reported to be associated with lower risk for midterm restenosis and repeat revascularization after bare-metal stent implantation. However, the influence of sex on very long-term outcomes after bare-metal stent implantation has not been yet reported. METHODS AND RESULTS: Among the 9877 patients in the multicenter Coronary Revascularization Demonstrating Outcome study in Kyoto (CREDO-Kyoto) registry cohort-1, bare-metal stent implantation was performed in 5313 patients (men, n=3742 and women, n=1571). Follow-up was completed in 4515 patients (85.0%) at 10 years (duration, 10.3 ± 3.1 [0.0-14.1] years). The cumulative incidence of target-lesion revascularization (TLR) was 27% at 1 year and 34% at 10 years (0.8%/y beyond 1 year). Non-target-lesion revascularization (non-TLR) was the dominant coronary revascularization beyond 1 year (13% at 1 year and 31% at 10 years [2.0%/y beyond 1 year]). Cumulative incidence of stent thrombosis was low (1.2% at 1 year and 1.9% at 10 years). Women were older and had greater prevalence of cardiovascular risk factors than men. The cumulative 10-year incidences of and adjusted risk for TLR were significantly higher in men than in women (36% versus 30%, P<0.001; adjusted hazard ratio, 1.29; 95% confidence interval, 1.15-1.46; P<0.001). The higher risk of men relative to women for TLR was consistent regardless of age (<75 years and ≥ 75 years). Men in comparison with women were also associated with significantly higher adjusted risks for all-cause death, myocardial infarction, stroke, coronary artery bypass grafting, TLR, and non-TLR. CONCLUSIONS: TLR and stent thrombosis continued to occur without attenuation up to 10 years after bare-metal stent implantation. Men in comparison with women were associated with higher adjusted 10-year risks for all-cause death, myocardial infarction, stroke, coronary artery bypass grafting, TLR, and non-TLR.
Authors: Gábor Csató; Nóra Erdei; Beatrix Ványai; Tímea Balla; Dániel Czuriga; Zoltán Csanádi; Zsolt Koszegi; István Édes; Gábor Tamás Szabó Journal: Front Cardiovasc Med Date: 2022-07-22