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Kurihara K, Kawamoto S, Kimura A, Tanaka A, Yabe K, Nomoto H, Osaka Y, Miyazaki T, Suzuki A, Ono Y, Otomo K, Sasano T. Five-Year Impacts of Antithrombotic Therapy Based on 10-Year Clinical Outcomes of Cypher™ Stent Implantation. Cardiol Ther 2022; 11:433-444. [PMID: 35729308 PMCID: PMC9381656 DOI: 10.1007/s40119-022-00267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Few researchers have investigated the optimal long-term antithrombotic therapy regimen, especially after first-generation drug-eluting stent (DES) use. This study aimed to evaluate the impact of mid-term antithrombotic therapy on long-term outcomes in patients treated with the first sirolimus-eluting coronary stent (Cypher™). Methods Between 2004 and 2009, 1021 patients underwent Cypher™ implantation at our institute; among them, 567 patients had available data on antithrombotic therapy at year 5. We assessed patients’ antithrombotic therapy at year 5 post Cypher™ implantation and examined their association with adverse events from year 5 to year 10 post Cypher™ implantation. Results Patients with dual-antiplatelet therapy (DAPT) at year 5 had significantly lower risk of stent thrombosis (ST) than those with single-antiplatelet therapy (SAPT) (hazard ratio [HR] 0.24, p = 0.034). The HR of major bleeding in DAPT, compared to SAPT, was high, but the difference was not significant (HR 1.72, p = 0.26). Risk of major bleeding was significantly higher in patients on oral anticoagulants (OAC) than in those in other groups (OAC/SAPT; HR 5.31, p = 0.0048, OAC/DAPT; HR 3.08, p = 0.022), without significant reduction in the risk of cardiovascular events. Conclusions The incidence of ST after Cypher™ implantation in patients with DAPT at year 5 was significantly lower than that in SAPT. However, the risk of bleeding was higher with DAPT than with SAPT. Moreover, the risk of major bleeding was significantly higher in patients on anticoagulant therapy than in other patients. New options for the use of antithrombotic drugs after percutaneous coronary intervention warrant further studies on the optimal antithrombotic therapy for first-generation DES.
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Affiliation(s)
- Ken Kurihara
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan.
| | - Shiho Kawamoto
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Ayaka Kimura
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Akifumi Tanaka
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Kento Yabe
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Hidetsugu Nomoto
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Yuki Osaka
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Toru Miyazaki
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Asami Suzuki
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Yuichi Ono
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Kenichiro Otomo
- Ome Municipal General Hospital, 4-16-5 Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyoku, Tokyo, 113-8519, Japan
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Kurihara K, Ashikaga T, Sasaoka T, Yoshikawa S, Isobe M. Incidence and predictors of early and late target lesion revascularization after everolimus-eluting stent implantation in unselected patients in japan. Catheter Cardiovasc Interv 2017; 90:78-86. [PMID: 28295926 DOI: 10.1002/ccd.26964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 12/21/2016] [Accepted: 01/16/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study was to clarify the incidence and predictors of early and late target lesion revascularization (TLR) after everolimus-eluting stent (EES) implantation in actual clinical practice. BACKGROUND Several clinical studies have reported the incidence and predictors of TLR after EES implantation. However, detailed features of early and late TLR are unknown. METHODS We analyzed the clinical data of patients who underwent EES implantation between January 2010 and December 2011 at 22 institutions in Japan (Tokyo-MD PCI study). Patients who underwent ischemia-driven TLR (ID-TLR) were grouped according to the number of years elapsed since stent placement, and incidence and correlations between clinical factors were analyzed. RESULTS Statistical analysis was performed for 1,899 patients and 2,305 lesions. The mean age was 70.0 ± 9.9 years, and the median follow-up period was 1,281 days (IQR: 762-1,440 days). The incidence of ID-TLR was 2.7% at 1 year and 5.4% at 4 years. After 2 years, the ID-TLR rates plateaued. The independent predictors of ID-TLR occurring within 2 years were hemodialysis, triple vessel disease, restenotic lesion, and ostial lesions. The independent predictors of ID-TLR between 2 and 4 years were diabetes mellitus and peripheral artery disease. CONCLUSION The ID-TLR rates leveled off after 2 years. Furthermore, the predictors of ID-TLR that occurred within 2 years of EES implantation differed from those that occurred later than 2 years. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Ken Kurihara
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taro Sasaoka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunji Yoshikawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Mennuni MG, Presbitero P. In-Stent Restenosis in New Generation DES Era. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marco G. Mennuni
- Department of Cardiology; Humanitas Research Hospital; Rozzano Milan Italy
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