Antiplatelet Therapy and Stent Thrombosis After Sirolimus-Eluting Stent Implantation

Abstract

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%, PϽ0.001; 0.72% versus 0.07%, Pϭ0.02; and 2.1% versus 0.14%, Pϭ0.004, 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 (Pϭ0.99) 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. (Circulation. 2009;119:987-995.)

One‐year clinical outcomes after sirolimus‐eluting coronary stent implantation in diabetics enrolled in the worldwide e‐SELECT registry

“…Clinical results after PCI with first-generation SES have been reported in many large randomized controlled trials, clinical registries, and small single-center series (Table III, Supporting Information Appendix) [10][11][12][13]. Our data confirm the safety and efficacy of PCI using first-generation SES, extending previous observations in a very large consecutive and unselected cohort of DM patients.…”

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

“…9,[55][56][57] Although East Asian patients have a higher prevalence of high on-treatment platelet reactivity during clopidogrel treatment than white patients, 9,51 the incidence of adverse ischaemic outcomes or stent thrombosis after PCI is similar or lower than that in white patients. [58][59][60][61] Analysis of data from the US National Cardiovascular Data Registry showed that Asian patients undergoing coronary stent implantation had a lower adjusted risk for the compo site end point of death, MI, and repeat revascularization than white patients (HR 0.89, 95% CI 0.82-0.96, P value not given). 58 In this analysis, the individual end point of death was slightly lower in Asian patients than in white patients, and the incidence of MI was similar in each group.…”

“…The incidence of stent thrombosis reported in South Korean and Japanese registries (~0.2% per year) is lower than that in Western registries (~0.6% per year) after first-generatio n drugeluting stent implantation. [59][60][61] This finding of a higher prevalence of high on-treatment platelet reactivity, but a thrombotic event rate after PCI that is similar or lower in East Asian patients than in white patients, has been called the 'East Asian paradox' . 9 Multiple factors are likely to be associated with the differences in thrombogenicity between East Asian and white individuals, and might explain the variation in propensity for thrombosis.…”

Impact of CYP2C19 Polymorphism on Platelet Function Tests and Coagulation and Inflammatory Biomarkers in Patients Undergoing Percutaneous Coronary Intervention

“…In a recent study of healthy Westerners, the prevalence of carriers of the CYP2C19 reduced-function allele was 30% in the total study population 14) . However, adverse cardiovascular events, including stent thrombosis after primary or elective PCI, are lower in Japanese individuals than in Westerners [39][40][41] , although the frequency of carriers of at least one CYP2C19 reduced-function allele is higher in Japanese patients than Western patients. The reason for the low risk of adverse cardiovascular events, including stent thrombosis, in Japan remains unknown; however, it is possible that other factors, such as the PCI procedure, the characteristics of the culprit coronary plaques or coronary risk factors, in addition to platelet aggregation, may influence the clinical outcomes of CAD patients treated with clopidogrel.…”