Cardiovascular Intervention and Therapeutics

, Volume 27, Issue 3, pp 181–188

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

  • 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 Mitudo
Original Article

DOI: 10.1007/s12928-012-0109-0

Cite this article as:
Kimura, T., Morimoto, T., Nakagawa, Y. et al. Cardiovasc Interv and Ther (2012) 27: 181. doi:10.1007/s12928-012-0109-0

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.

Keywords

StentsThrombosisAntiplatelet therapyCoronary artery diseasePrognosis

Supplementary material

12928_2012_109_MOESM1_ESM.doc (34 kb)
Supplementary material 1 (DOC 34 kb)

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2012

Authors and Affiliations

  • Takeshi Kimura
    • 1
  • Takeshi Morimoto
    • 2
  • Yoshihisa Nakagawa
    • 3
  • Kazushige Kadota
    • 4
  • Yoichi Nozaki
    • 5
  • Tomohisa Tada
    • 1
  • Shunsuke Take
    • 6
  • Kinya Shirota
    • 7
  • Akira Ito
    • 8
  • Hitoshi Nakashima
    • 9
  • Hiroshi Fujita
    • 10
  • Tomohiro Kawasaki
    • 11
  • Tsukasa Inada
    • 12
  • Koichi Nakao
    • 13
  • Shunichi Miyazaki
    • 14
  • Osamu Doi
    • 15
  • Takaaki Isshiki
    • 16
  • Masakiyo Nobuyoshi
    • 17
  • Kazuaki Mitudo
    • 4
  1. 1.Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
  2. 2.Center for General Internal Medicine and Emergency CareKinki University School of MedicineOsakaJapan
  3. 3.Division of CardiologyTenri HospitalTenriJapan
  4. 4.Department of CardiologyKurashiki Central HospitalKurashikiJapan
  5. 5.Division of CardiologyHokko Memorial HospitalSapporoJapan
  6. 6.Division of CardiologySaiseikai Noe HospitalOsakaJapan
  7. 7.Division of CardiologyMatsue Red Cross HospitalMatsueJapan
  8. 8.Division of CardiologyOsaka City General HospitalOsakaJapan
  9. 9.Division of CardiologyNational Hospital Organization Kagoshima Medical CenterKagoshimaJapan
  10. 10.Division of CardiologyKyoto Second Red Cross HospitalKyotoJapan
  11. 11.Division of CardiologyShin-Koga HospitalKurumeJapan
  12. 12.Division of CardiologyOsaka Red Cross HospitalOsakaJapan
  13. 13.Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamotoJapan
  14. 14.Division of Cardiology, Department of Internal MedicineKinki University School of MedicineOsakaJapan
  15. 15.Division of CardiologyShizuoka General HospitalShizuokaJapan
  16. 16.Division of CardiologyTeikyo University HospitalTokyoJapan
  17. 17.Division of CardiologyKokura Memorial HospitalKitakyushuJapan