Antiplatelet therapy discontinuation and the risk of serious cardiovascular events after coronary stenting: observations from the CREDO-Kyoto Registry Cohort-2

• Published in: PloS one 2015-04, Vol.10 (4), p.e0124314-e0124314
• Main Authors: Watanabe, Hirotoshi, Morimoto, Takeshi, Natsuaki, Masahiro, Furukawa, Yutaka, Nakagawa, Yoshihisa, Kadota, Kazushige, Yamaji, Kyohei, Ando, Kenji, Shizuta, Satoshi, Shiomi, Hiroki, Tada, Tomohisa, Tazaki, Junichi, Kato, Yoshihiro, Hayano, Mamoru, Abe, Mitsuru, Tamura, Takashi, Shirotani, Manabu, Miki, Shinji, Matsuda, Mitsuo, Takahashi, Mamoru, Ishii, Katsuhisa, Tanaka, Masaru, Aoyama, Takeshi, Doi, Osamu, Hattori, Ryuichi, Kato, Masayuki, Suwa, Satoru, Takizawa, Akinori, Takatsu, Yoshiki, Shinoda, Eiji, Eizawa, Hiroshi, Takeda, Teruki, Lee, Jong-Dae, Inoko, Moriaki, Ogawa, Hisao, Hamasaki, Shuichi, Horie, Minoru, Nohara, Ryuji, Kambara, Hirofumi, Fujiwara, Hisayoshi, Mitsudo, Kazuaki, Nobuyoshi, Masakiyo, Kita, Toru, Kastrati, Adnan, Kimura, Takeshi
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Antiplatelet therapy; Aspirin; Aspirin - therapeutic use; Cardiology; Cardiovascular diseases; Cerebral infarction; Complications and side effects; Coronary Restenosis - etiology; Coronary Restenosis - pathology; Coronary Restenosis - prevention & control; Coronary vessels; Development and progression; Drug-Eluting Stents - adverse effects; Female; Health risks; Heart attacks; Heart surgery; Humans; Implantation; Implants; Incidence; Intervention; Ischemia; Japan; Male; Medicine; Middle Aged; Myocardial infarction; Myocardial Infarction - etiology; Myocardial Infarction - pathology; Myocardial Infarction - prevention & control; Patient outcomes; Patients; Platelet aggregation inhibitors; Platelet Aggregation Inhibitors - therapeutic use; Primary care; Rapamycin; Registries; Risk; Stents; Stroke; Stroke - etiology; Stroke - pathology; Stroke - prevention & control; Surgical implants; Therapy; Thienopyridines - therapeutic use; Thromboembolism; Thrombosis; Thrombosis - etiology; Thrombosis - pathology; Thrombosis - prevention & control; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0124314

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