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

PLoS One. 2015 Apr 8;10(4):e0124314. doi: 10.1371/journal.pone.0124314. eCollection 2015.

Abstract

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.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects
  • Aspirin / therapeutic use
  • Coronary Restenosis / etiology*
  • Coronary Restenosis / pathology
  • Coronary Restenosis / prevention & control
  • Drug-Eluting Stents / adverse effects*
  • Female
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology*
  • Myocardial Infarction / pathology
  • Myocardial Infarction / prevention & control
  • Platelet Aggregation Inhibitors / therapeutic use
  • Registries*
  • Risk
  • Stroke / etiology*
  • Stroke / pathology
  • Stroke / prevention & control
  • Thienopyridines / therapeutic use
  • Thrombosis / etiology*
  • Thrombosis / pathology
  • Thrombosis / prevention & control

Substances

  • Platelet Aggregation Inhibitors
  • Thienopyridines
  • Aspirin

Grants and funding

The source of funding of CREDO-Kyoto PCI/CABG Registry Cohort-2 is Pharmaceuticals and Medical Devices Agency (PMDA), Tokyo, Japan (http://www.pmda.go.jp/). TK (T. Kimura) received the funding. PMDA had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.