Long-Term Efficacy and Safety Outcomes After Unrestricted Use of Drug-Eluting Stents in Patients With Acute Coronary Syndrome

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  • Kawaji Tetsuma
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
  • Shiomi Hiroki
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
  • Morimoto Takeshi
    Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine
  • Tamura Toshihiro
    Department of Cardiovascular Medicine, Tenri Hospital
  • Nishikawa Ryusuke
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
  • Yano Mariko
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
  • Tazaki Junichi
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
  • Imai Masao
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
  • Saito Naritatsu
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
  • Makiyama Takeru
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
  • Shizuta Satoshi
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
  • Ono Koh
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
  • Kimura Takeshi
    Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University

Bibliographic Information

Other Title
  • Long-Term Efficacy and Safety Outcomes After Unrestricted Use of Drug-Eluting Stents in Patients With Acute Coronary Syndrome : Mortality and Major Bleeding in a Single-Center Registry
  • – Mortality and Major Bleeding in a Single-Center Registry –

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Abstract

Background: Recent randomized clinical trials have reported favorable clinical outcomes after the use of drug-eluting stents (DES) in patients with acute coronary syndrome (ACS). However, the long-term efficacy and safety outcomes, bleeding outcome in particular, after DES implantation in ACS patients have not been thoroughly evaluated in a real-world population. Methods and Results: We evaluated long-term clinical outcomes in 565 consecutive ACS patients who underwent DES implantation in an emergency setting between 2004 and 2011 (ST-segment elevation acute myocardial infarction [STEMI]: n=269, non-STEMI/unstable angina pectoris: n=296). Mean clinical follow-up period in this study was 4.6±2.0 years. The cumulative incidence of all-cause death, cardiac death, myocardial infarction, stent thrombosis and target-lesion revascularization was 6.9%, 4.0%, 2.2%, 1.3% and 8.4% at 1 year, and 19.6%, 6.7%, 5.6%, 3.0% and 13.9% at 5 years, respectively. The cumulative 5-year incidence of major bleeding events was 8.4% (n=42). Fatal bleeding events, however, occurred in only 4 patients, even including 2 patients who required resuscitation upon arrival at the hospital. Of the 42 patients with major bleeding events, 39 were taking dual antiplatelet therapy (DAPT) at the time of bleeding. Conclusions: DES implantation provided favorable long-term clinical outcomes with an acceptably low incidence of fatal bleeding in a real-world population of ACS patients. However, prolonged DAPT seems to be associated with major bleeding after DES implantation. (Circ J 2014; 78: 1628–1635)

Journal

  • Circulation Journal

    Circulation Journal 78 (7), 1628-1635, 2014

    The Japanese Circulation Society

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