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Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents

BACKGROUND: There are limited data on the long-term stent-related adverse events as related to the duration of dual antiplatelet therapy (DAPT) in second-generation (G2) drug-eluting stents (DES) compared with first-generation (G1) DES. OBJECTIVES: This study sought to compare the long-term stent-re...

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Autores principales: Yoshikawa, Yusuke, Shiomi, Hiroki, Morimoto, Takeshi, Takeji, Yasuaki, Matsumura-Nakano, Yukiko, Yamamoto, Ko, Yamamoto, Erika, Kato, Eri T., Watanabe, Hirotoshi, Saito, Naritatsu, Domei, Takenori, Tada, Takeshi, Nawada, Ryuzo, Onodera, Tomoya, Suwa, Satoru, Tamura, Toshihiro, Ishii, Katsuhisa, Ando, Kenji, Furukawa, Yutaka, Kadota, Kazushige, Nakagawa, Yoshihisa, Kimura, Takeshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9627913/
https://www.ncbi.nlm.nih.gov/pubmed/36341224
http://dx.doi.org/10.1016/j.jacasi.2021.08.010
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author Yoshikawa, Yusuke
Shiomi, Hiroki
Morimoto, Takeshi
Takeji, Yasuaki
Matsumura-Nakano, Yukiko
Yamamoto, Ko
Yamamoto, Erika
Kato, Eri T.
Watanabe, Hirotoshi
Saito, Naritatsu
Domei, Takenori
Tada, Takeshi
Nawada, Ryuzo
Onodera, Tomoya
Suwa, Satoru
Tamura, Toshihiro
Ishii, Katsuhisa
Ando, Kenji
Furukawa, Yutaka
Kadota, Kazushige
Nakagawa, Yoshihisa
Kimura, Takeshi
author_facet Yoshikawa, Yusuke
Shiomi, Hiroki
Morimoto, Takeshi
Takeji, Yasuaki
Matsumura-Nakano, Yukiko
Yamamoto, Ko
Yamamoto, Erika
Kato, Eri T.
Watanabe, Hirotoshi
Saito, Naritatsu
Domei, Takenori
Tada, Takeshi
Nawada, Ryuzo
Onodera, Tomoya
Suwa, Satoru
Tamura, Toshihiro
Ishii, Katsuhisa
Ando, Kenji
Furukawa, Yutaka
Kadota, Kazushige
Nakagawa, Yoshihisa
Kimura, Takeshi
author_sort Yoshikawa, Yusuke
collection PubMed
description BACKGROUND: There are limited data on the long-term stent-related adverse events as related to the duration of dual antiplatelet therapy (DAPT) in second-generation (G2) drug-eluting stents (DES) compared with first-generation (G1) DES. OBJECTIVES: This study sought to compare the long-term stent-related outcomes of G2-DES with those of G1-DES. METHODS: The study group consisted of 15,009 patients who underwent their first coronary revascularization with DES from the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) Registry Cohort-2 (first-generation drug-eluting stent [G1-DES] period; n = 5,382) and Cohort-3 (second-generation drug eluting stent [G2-DES] period; n = 9,627). The primary outcome measures were definite stent thrombosis (ST) and target vessel revascularization (TVR). RESULTS: The cumulative 5-year incidences of definite ST and TVR were significantly lower in the G2-DES group than in the G1-DES group (0.7% vs 1.4%; P < 0.001; and 16.2% vs 22.1%; P < 0.001, respectively). The lower adjusted risk of G2-DES relative to G1-DES for definite ST and TVR remained significant (HR: 0.53; 95% CI: 0.37-0.76; P < 0.001; and HR: 0.74; 95% CI: 0.68-0.81; P < 0.001, respectively). In the landmark analysis that was based on the DAPT status at 1 year, the lower adjusted risk of on-DAPT status relative to off-DAPT was significant for definite ST beyond 1 year in the G1-DES stratum (HR: 0.42; 95% CI: 0.24-0.76; P = 0.004) but not in the G2-DES stratum (HR: 0.66; 95% CI: 0.26-1.68; P = 0.38) (P(interaction) = 0.14). CONCLUSIONS: G2-DES compared with G1-DES were associated with a significantly lower risk for stent-related adverse events, including definite ST and TVR. DAPT beyond 1 year was associated with a significantly lower risk for very late ST of G1-DES but not for that of G2-DES.
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spelling pubmed-96279132022-11-04 Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents Yoshikawa, Yusuke Shiomi, Hiroki Morimoto, Takeshi Takeji, Yasuaki Matsumura-Nakano, Yukiko Yamamoto, Ko Yamamoto, Erika Kato, Eri T. Watanabe, Hirotoshi Saito, Naritatsu Domei, Takenori Tada, Takeshi Nawada, Ryuzo Onodera, Tomoya Suwa, Satoru Tamura, Toshihiro Ishii, Katsuhisa Ando, Kenji Furukawa, Yutaka Kadota, Kazushige Nakagawa, Yoshihisa Kimura, Takeshi JACC Asia Original Research BACKGROUND: There are limited data on the long-term stent-related adverse events as related to the duration of dual antiplatelet therapy (DAPT) in second-generation (G2) drug-eluting stents (DES) compared with first-generation (G1) DES. OBJECTIVES: This study sought to compare the long-term stent-related outcomes of G2-DES with those of G1-DES. METHODS: The study group consisted of 15,009 patients who underwent their first coronary revascularization with DES from the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) Registry Cohort-2 (first-generation drug-eluting stent [G1-DES] period; n = 5,382) and Cohort-3 (second-generation drug eluting stent [G2-DES] period; n = 9,627). The primary outcome measures were definite stent thrombosis (ST) and target vessel revascularization (TVR). RESULTS: The cumulative 5-year incidences of definite ST and TVR were significantly lower in the G2-DES group than in the G1-DES group (0.7% vs 1.4%; P < 0.001; and 16.2% vs 22.1%; P < 0.001, respectively). The lower adjusted risk of G2-DES relative to G1-DES for definite ST and TVR remained significant (HR: 0.53; 95% CI: 0.37-0.76; P < 0.001; and HR: 0.74; 95% CI: 0.68-0.81; P < 0.001, respectively). In the landmark analysis that was based on the DAPT status at 1 year, the lower adjusted risk of on-DAPT status relative to off-DAPT was significant for definite ST beyond 1 year in the G1-DES stratum (HR: 0.42; 95% CI: 0.24-0.76; P = 0.004) but not in the G2-DES stratum (HR: 0.66; 95% CI: 0.26-1.68; P = 0.38) (P(interaction) = 0.14). CONCLUSIONS: G2-DES compared with G1-DES were associated with a significantly lower risk for stent-related adverse events, including definite ST and TVR. DAPT beyond 1 year was associated with a significantly lower risk for very late ST of G1-DES but not for that of G2-DES. Elsevier 2021-11-23 /pmc/articles/PMC9627913/ /pubmed/36341224 http://dx.doi.org/10.1016/j.jacasi.2021.08.010 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Yoshikawa, Yusuke
Shiomi, Hiroki
Morimoto, Takeshi
Takeji, Yasuaki
Matsumura-Nakano, Yukiko
Yamamoto, Ko
Yamamoto, Erika
Kato, Eri T.
Watanabe, Hirotoshi
Saito, Naritatsu
Domei, Takenori
Tada, Takeshi
Nawada, Ryuzo
Onodera, Tomoya
Suwa, Satoru
Tamura, Toshihiro
Ishii, Katsuhisa
Ando, Kenji
Furukawa, Yutaka
Kadota, Kazushige
Nakagawa, Yoshihisa
Kimura, Takeshi
Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents
title Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents
title_full Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents
title_fullStr Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents
title_full_unstemmed Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents
title_short Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents
title_sort stent-related adverse events as related to dual antiplatelet therapy in first- vs second-generation drug-eluting stents
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9627913/
https://www.ncbi.nlm.nih.gov/pubmed/36341224
http://dx.doi.org/10.1016/j.jacasi.2021.08.010
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