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(Circulation. 2009;119:987-995.)
© 2009 American Heart Association, Inc.

Interventional Cardiology

Antiplatelet Therapy and Stent Thrombosis After Sirolimus-Eluting Stent Implantation

Takeshi Kimura, MD; Takeshi Morimoto, MD; Yoshihisa Nakagawa, MD; Toshihiro Tamura, MD; Kazushige Kadota, MD; Hitoshi Yasumoto, MD; Hideo Nishikawa, MD; Yoshikazu Hiasa, MD; Toshiya Muramatsu, MD; Taiichiro Meguro, MD; Naoto Inoue, MD; Hidehiko Honda, MD; Yasuhiko Hayashi, MD; Shunichi Miyazaki, MD; Shigeru Oshima, MD; Takashi Honda, MD; Nobuo Shiode, MD; Masanobu Namura, MD; Takahito Sone, MD; Masakiyo Nobuyoshi, MD; Toru Kita, MD; Kazuaki Mitsudo, MD, for the j-Cypher Registry Investigators

From the Department of Cardiovascular Medicine (T. Kimura, T.T., T. Kita) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Tenri Hospital (Y.N.), Tenri City, Japan; Division of Cardiology, Kurashiki Central Hospital (K.K., K.M.), Kurashiki, Japan; Division of Cardiology, Kokura Memorial Hospital (H.Y., M. Nobuyoshi), Kokura, Japan; Mie Heart Center (H.N.), Mie, Japan; Division of Cardiology, Tokushima Red Cross Hospital (Y. Hiasa), Komatsushima City, Japan; Division of Cardiology, Kawasaki Social Insurance Hospital (T. Muramatsu), Kawasaki City, Japan; Division of Cardiology, Sendai Health Hospital (T. Meguro, N.I., H.H.), Sendai, Japan; Division of Cardiology, Tsuchiya General Hospital (Y. Hayashi), Hiroshima, Japan; Division of Cardiology, National Cardiovascular Center (S.M.), Suita City, Japan; Division of Cardiology, Gunma Prefecture Cardiovascular Center (S.O.), Maebashi, Japan; Division of Cardiology, Saiseikai Kumamoto Hospital (T.H.), Kumamoto, Japan; Division of Cardiology, Matsue Red Cross Hospital (N.S.), Matsue, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital (M. Namura), Kanazawa, Japan; and Division of Cardiology, Ogaki Municipal Hospital (T.S.), Ogaki, Japan.

Correspondence to Takeshi Kimura, Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 Japan. E-mail taketaka{at}kuhp.kyoto-u.ac.jp

Received July 18, 2008; accepted November 30, 2008.

Background— The influences of antiplatelet therapy discontinuation on the risk of stent thrombosis and long-term clinical outcomes after drug-eluting stent implantation have not yet been addressed adequately.

Methods and Results— In an observational study in Japan, 2-year outcomes were assessed in 10 778 patients undergoing sirolimus-eluting stent implantation. Data on status of antiplatelet therapy during follow-up were collected prospectively. Incidences of definite stent thrombosis were 0.34% at 30 days, 0.54% at 1 year, and 0.77% at 2 years. Thienopyridine use was maintained in 97%, 62%, and 50% of patients at 30 days, 1 year, and 2 years, respectively. Patients who discontinued both thienopyridine and aspirin had a significantly higher rate of stent thrombosis than those who continued both in the intervals of 31 to 180 days, 181 to 365 days, and 366 to 548 days after stent implantation (1.76% versus 0.1%, P<0.001; 0.72% versus 0.07%, P=0.02; and 2.1% versus 0.14%, P=0.004, respectively). When discontinuation of aspirin was taken into account, patients who discontinued thienopyridine only did not have an excess of stent thrombosis in any of the time intervals studied. Adjusted rates of death or myocardial infarction at 24 months were 4.1% for patients taking thienopyridine and 4.1% for patients not taking thienopyridine (P=0.99) in the 6-month landmark analysis.

Conclusions— Discontinuation of both thienopyridine and aspirin, but not discontinuation of thienopyridine therapy only, was associated with an increased risk of stent thrombosis. Landmark analysis did not suggest an apparent clinical benefit of thienopyridine use beyond 6 months after sirolimus-eluting stent implantation.

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