• Tomohisa Tada, Masahiro Natsuaki, Takeshi Morimoto, Yutaka Furukawa, Yoshihisa Nakagawa, Robert A Byrne, Adnan Kastrati, Kazushige Kadota, Masashi Iwabuchi, Satoshi Shizuta, Junichi Tazaki, Hiroki Shiomi, Mitsuru Abe, Natsuhiko Ehara, Tetsu Mizoguchi, Hirokazu Mitsuoka, Tsukasa Inada, Makoto Araki, Satoshi Kaburagi, Ryoji Taniguchi, Hiroshi Eizawa, Akira Nakano, Satoru Suwa, Akinori Takizawa, Ryuji Nohara, Hisayoshi Fujiwara, Kazuaki Mitsudo, Masakiyo Nobuyoshi, Toru Kita, Takeshi Kimura, and CREDO-Kyoto PCI/CABG Registry Cohort-2 Investigators.
• Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
• Circ Cardiovasc Interv. 2012 Jun 1;5(3):381-91.

BackgroundOptimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been yet fully elucidated.Methods And ResultsWe assessed the influence of prolonged thienopyridine therapy on clinical outcomes with landmark analysis at 4 and 13 months after DES implantation. Among 6802 patients with at least 1 DES implantation in the CREDO-Kyoto Registry Cohort-2, 6309 patients (on thienopyridine, 5438 patients; off thienopyridine, 871 patients) and 5901 patients (on thienopyridine, 4098 patients; off thienopyridine, 1803 patients) were eligible for the 4- and 13-month landmark analyses, respectively. The majority of patients had stable coronary artery disease (73%) and received sirolimus-eluting stents (93%), and approximately 90% of thienopyridine was ticlopidine. Patients taking thienopyridine had more complex comorbidities and more complex lesion and procedural characteristics as compared with patients not taking thienopyridine. After adjusting for confounders, thienopyridine use was not associated with decreased risk for death/myocardial infarction/stroke (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.89-1.43, P=0.32 in the 4-month landmark analysis; HR, 1.14; 95% CI, 0.90-1.45, P=0.29 in the 13-month landmark analysis, respectively), whereas the risk for GUSTO moderate/severe bleeding tended to be higher in patients taking thienopyridine (HR, 1.51; 95% CI, 1.00-2.23, P=0.049 in the 4-month landmark analysis; HR, 1.44; 95% CI, 0.99-2.09, P=0.057 in the 13-month landmark analysis, respectively).ConclusionsProlonged thienopyridine therapy beyond 4 and 13 months appeared not to be associated with reduction in ischemic events but to be associated with a trend toward increased bleeding. Optimal duration of DAPT after DES implantation might be shorter than the currently recommended 1-year interval.

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