PLoS ONE (Jan 2015)

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

  • Hirotoshi Watanabe,
  • Takeshi Morimoto,
  • Masahiro Natsuaki,
  • Yutaka Furukawa,
  • Yoshihisa Nakagawa,
  • Kazushige Kadota,
  • Kyohei Yamaji,
  • Kenji Ando,
  • Satoshi Shizuta,
  • Hiroki Shiomi,
  • Tomohisa Tada,
  • Junichi Tazaki,
  • Yoshihiro Kato,
  • Mamoru Hayano,
  • Mitsuru Abe,
  • Takashi Tamura,
  • Manabu Shirotani,
  • Shinji Miki,
  • Mitsuo Matsuda,
  • Mamoru Takahashi,
  • Katsuhisa Ishii,
  • Masaru Tanaka,
  • Takeshi Aoyama,
  • Osamu Doi,
  • Ryuichi Hattori,
  • Masayuki Kato,
  • Satoru Suwa,
  • Akinori Takizawa,
  • Yoshiki Takatsu,
  • Eiji Shinoda,
  • Hiroshi Eizawa,
  • Teruki Takeda,
  • Jong-Dae Lee,
  • Moriaki Inoko,
  • Hisao Ogawa,
  • Shuichi Hamasaki,
  • Minoru Horie,
  • Ryuji Nohara,
  • Hirofumi Kambara,
  • Hisayoshi Fujiwara,
  • Kazuaki Mitsudo,
  • Masakiyo Nobuyoshi,
  • Toru Kita,
  • Adnan Kastrati,
  • Takeshi Kimura,
  • CREDO-Kyoto PCI/CABG registry cohort-2 investigators

DOI
https://doi.org/10.1371/journal.pone.0124314
Journal volume & issue
Vol. 10, no. 4
p. e0124314

Abstract

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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<0.001/P<0.001), while higher risk of no-APT for ST was evident only until 6-month after BMS implantation (incidence rates between 1- and 6-month: 8.43 versus 0.71/1.20, P<0.001/P<0.001, and cumulative incidence rates beyond 6-month: 0.31 versus 0.11/0.08, P=0.16/P=0.08). No-APT as compared with dual- or single-APT was also associated with significantly higher risk for spontaneous myocardial infarction (MI) and stroke regardless of the types of stents implanted. Single-APT as compared with dual-APT was not associated with higher risk for serious adverse events, except for the marginally higher risk for ST in the SES stratum. In conclusion, discontinuation of both aspirin and thienopyridines was associated with increased risk for serious cardiovascular events including ST, spontaneous MI and stroke beyond 1-month after coronary stenting.