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Short versus prolonged dual antiplatelet therapy duration after bare-metal stent implantation: 2-month landmark analysis from the CREDO-Kyoto registry cohort-2

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Abstract

One-month duration of dual antiplatelet therapy (DAPT) has widely been adopted after bare-metal stent (BMS) implantation in the real clinical practice. However, it has not been adequately addressed yet whether DAPT for only 1-month could provide sufficient protection from ischemic events beyond 1-month after BMS implantation. We assessed the effects of short DAPT relative to prolonged DAPT on clinical outcomes with the landmark analysis at 2 month after BMS implantation. Among 13,058 consecutive patients enrolled in the CREDO-Kyoto registry cohort-2, this study population consisted of 4905 patients treated with BMS only in whom the information on the status of antiplatelet therapy was available at 2 month after stent implantation [single-antiplatelet therapy (SAPT) group: N = 2575 (acute myocardial infarction (AMI): N = 1257, and non-AMI: N = 1318), and DAPT group: N = 2330 (AMI: N = 1304, and non-AMI: N = 1026)]. Cumulative 3-year incidence of the primary outcome measure (a composite of cardiovascular death, myocardial infarction, stroke, definite stent thrombosis, and GUSTO moderate/severe bleeding) was not significantly different between the SAPT and DAPT groups (9.8 versus 10.6 %, P = 0.34). After adjusting confounders, the risk of SAPT relative to DAPT for the primary outcome measure remained insignificant in the entire cohort (HR 0.97, 95 % CI 0.79–1.19, P = 0.77), and in both AMI and non-AMI strata without any significant interaction between clinical presentation (AMI versus non-AMI) and the effect of SAPT relative to DAPT (P interaction = 0.56). In conclusion, short DAPT <2 month after BMS implantation was as safe as prolonged DAPT ≥2-month in both AMI and non-AMI patients.

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Acknowledgments

We appreciate the supports of the co-investigators participating in the CREDO-Kyoto PCI/CABG registry cohort-2.

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Authors and Affiliations

  1. Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan

    Masahiro Natsuaki

  2. Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan

    Takeshi Morimoto

  3. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan

    Yutaka Furukawa

  4. Division of Cardiology, Tenri Hospital, Tenri, Japan

    Yoshihisa Nakagawa

  5. Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan

    Kazushige Kadota

  6. Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan

    Kenji Ando & Katsumi Inoue

  7. Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Hiroki Shiomi, Toshiaki Toyota, Hirotoshi Watanabe, Koh Ono, Satoshi Shizuta & Takeshi Kimura

  8. Division of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

    Takashi Tamura

  9. Cardiovascular Center, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan

    Moriaki Inoko

  10. Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan

    Tsukasa Inada

  11. Division of Cardiology, Nara Hospital, Kindai University Faculty of Medicine, Nara, Japan

    Manabu Shirotani

  12. Division of Cardiology, Kishiwada City Hospital, Kishiwada, Japan

    Mitsuo Matsuda

  13. Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan

    Takeshi Aoyama

  14. Division of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan

    Tomoya Onodera

  15. Division of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan

    Satoru Suwa

  16. Division of Cardiology, Koto Memorial Hospital, Higashioumi, Japan

    Teruki Takeda

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  1. Masahiro Natsuaki
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  20. Teruki Takeda
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  21. Katsumi Inoue
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  22. Takeshi Kimura
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on behalf of the CREDO-Kyoto PCI/CABG registry cohort-2 investigators

Corresponding author

Correspondence to Takeshi Kimura.

Ethics declarations

The relevant review boards or ethics committees in all participating centers approved the research protocol. Because of retrospective enrollment, written informed consents from the patients were waived; however, we excluded those patients who refused participation in the study when contacted for follow-up. This strategy is concordant with the guidelines for epidemiological studies issued by the Ministry of Health, Labor and Welfare of Japan.

Conflict of interest

Pharmaceuticals and Medical Devices Agency (PMDA) is the funding source of this study. All authors have no conflict of interests.

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Natsuaki, M., Morimoto, T., Furukawa, Y. et al. Short versus prolonged dual antiplatelet therapy duration after bare-metal stent implantation: 2-month landmark analysis from the CREDO-Kyoto registry cohort-2. Cardiovasc Interv and Ther 33, 23–34 (2018). https://doi.org/10.1007/s12928-016-0429-6

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  • DOI: https://doi.org/10.1007/s12928-016-0429-6

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