Published Online
on February 9, 2009

A more recent version of this article appeared on February 24, 2009

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Submitted on July 18, 2008
Accepted on November 30, 2008

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.

^* To whom correspondence should be addressed. E-mail: taketaka{at}kuhp.kyoto-u.ac.jp.

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.

Key words: aspirin • follow-up studies • stents • coronary disease • thrombosis

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