Antiplatelet therapy and long-term clinical outcome after sirolimus-eluting stent implantation: 5-year outcome of the j-Cypher registry.

Abstract

Due to serious concerns on very late stent thrombosis (VLST), extended use of dual antiplatelet therapy (DAPT) beyond 1 year after DES implantation has become a common clinical practice despite apparent lack of evidence suggesting its efficacy in reducing VLST. The study population consisted of 12812 patients in the j-Cypher registry who were treated with at least one sirolimus-eluting stent (SES). We assessed the relation between duration of thienopyridine therapy and clinical outcomes with a landmark analysis at 1 year after SES implantation. Among 11713 patients without myocardial infarction (MI), stent thrombosis and stroke at 1 year who were eligible for the landmark analysis, 7414 patients (63 %) were maintained on thienopyridine at 1-year landmark point, while 4299 patients (37 %) had discontinued thienopyridine before 1-year landmark point. Patients in the on-thienopyridine group had more complex characteristics than patients in the off-thienopyridine group. Cumulative incidence of and the risk for definite VLST in the on-thienopyridine group relative to the off-thienopyridine group favored prolonged DAPT, but were not significant [0.9 and 1.2 %, P = 0.1, and adjusted HR (95 % CI): 0.71 (0.47-1.06), P = 0.11]. Cumulative incidence of and the risk for a composite of death, MI, or stroke in the on-thienopyridine group relative to the off-thienopyridine group were also not significant [15.3 and 14.3 %, P = 0.15, and adjusted HR (95 % CI): 0.99 (0.89-1.11), P = 0.89]. Prolonged use of thienopyridine beyond 1 year after SES implantation was not associated with significant decrease in the risks for VLST or for serious cardiovascular events including death, MI or stroke.

• Authors: Takeshi Kimura, Takeshi Morimoto, Yoshihisa Nakagawa, Kazushige Kadota, Yoichi Nozaki, Tomohisa Tada, Shunsuke Take, Kinya Shirota, Akira Ito, Hitoshi Nakashima, Hiroshi Fujita, Tomohiro Kawasaki, Tsukasa Inada, Koichi Nakao, Shunichi Miyazaki, Osamu Doi, Takaaki Isshiki, Masakiyo Nobuyoshi, Kazuaki Mitsudo, Kazuaki Mitudo
• Journal: Cardiovascular intervention and therapeutics (Cardiovasc Interv Ther) Vol. 27 Issue 3 Pg. 181-8 (Sep 2012) ISSN: 1868-4297 [Electronic] Japan
• PMID: 22695921 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Pyridines
• thienopyridine
• Sirolimus

Topics

• Aged
• Aged, 80 and over
• Coronary Artery Disease (drug therapy, therapy)
• Drug-Eluting Stents
• Female
• Follow-Up Studies
• Humans
• Male
• Platelet Aggregation Inhibitors (therapeutic use)
• Prognosis
• Prospective Studies
• Pyridines (therapeutic use)
• Registries
• Sirolimus (therapeutic use)
• Thrombosis (drug therapy)
• Treatment Outcome