Therapeutic strategies preventing late target lesion revascularization (TLR) after
drug-eluting stent implantation have not been yet adequately investigated. In 13,087
consecutive patients undergoing first percutaneous coronary intervention in the CREDO-Kyoto
Registry Cohort-2, we identified 10,221 patients who were discharged alive after implantation
of sirolimus-eluting stents (SESs) only (SES stratum 5,029) or bare-metal stents (BMSs)
only (BMS stratum 5,192). Impact of statin therapy at time of discharge from the index
hospitalization on early (within the first year) and late (1 year to 4 years) TLR,
was assessed in the SES stratum (statin group 2,735; nonstatin group 2,294) and in
the BMS stratum (statin group 2,576; nonstatin group 2,616). Despite a significantly
lower incidence of early TLR (7.8% vs 22.2%, p <0.0001), SES use compared to BMS use
was associated with a significantly higher incidence of late TLR (7.7% vs 3.0%, p
<0.0001). In the SES and BMS strata, the incidence of early TLR was similar regardless
of statin use. In the SES stratum, the incidence of late TLR was significantly lower
in the statin group than in the nonstatin group (6.1% vs 9.6%, p = 0.002), whereas
no significant difference was found in the BMS stratum (2.6% vs 3.3%, p = 0.38). After
adjusting confounders, risk for late TLR significantly favored statin use in the SES
stratum (hazard ratio 0.73, 95% confidence interval 0.54 to 0.98, p = 0.04), whereas
the risk decrease was not significant in the BMS stratum (hazard ratio 0.74, 95% confidence
interval 0.46 to 1.20, p = 0.23). In conclusion, statin therapy at hospital discharge
was associated with a significantly lower risk for late TLR after SES implantation.
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Article info
Publication history
Published online: March 01, 2012
Accepted:
January 2,
2012
Received in revised form:
January 2,
2012
Received:
November 18,
2011
Footnotes
This study was supported by the Pharmaceuticals and Medical Devices Agency, Tokyo, Japan.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
