Benefits and risks of prolonged dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent in patients with stable coronary artery disease and diabetes.
10.3760/cma.j.cn112148-20220114-00034
- VernacularTitle:稳定性冠心病合并糖尿病患者药物洗脱支架置入术后延长双联抗血小板治疗的获益与风险
- Author:
Kong Yong CUI
1
;
Dong YIN
1
;
Lei FENG
1
;
Cheng Gang ZHU
1
;
Wei Hua SONG
1
;
Hua Jian WANG
1
;
Lei JIA
1
;
Dong ZHANG
1
;
Sheng YUAN
1
;
Shao Yu WU
1
;
Ji Ning HE
1
;
Zheng QIAO
1
;
Ke Fei DOU
1
Author Information
1. Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
- Publication Type:Journal Article
- MeSH:
Coronary Artery Disease/therapy*;
Diabetes Mellitus, Type 2;
Drug Therapy, Combination;
Drug-Eluting Stents;
Hemorrhage;
Humans;
Percutaneous Coronary Intervention;
Platelet Aggregation Inhibitors/therapeutic use*;
Risk Assessment;
Treatment Outcome
- From:
Chinese Journal of Cardiology
2022;50(5):458-465
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To compare the efficacy and safety of prolonged dual antiplatelet therapy (DAPT>1 year) in patients with stable coronary artery disease (CAD) and diabetes who were event-free at 1 year after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in a large and contemporary PCI registry. Methods: A total of 1 661 eligible patients were selected from the Fuwai PCI Registry, of which 1 193 received DAPT>1 year and 468 received DAPT ≤1 year. The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE) and Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding, MACCE was defined as a composite of all-cause death, myocardial infarction or stroke. Multivariate Cox regression analysis and inverse probability of treatment weighting (IPTW) Cox regression analysis were performed. Results: After a median follow-up of 2.5 years, patients who received DAPT>1 year were associated with lower risks of MACCE (1.4% vs. 3.2%; hazard ratio (HR) 0.412, 95% confidence interval (CI) 0.205-0.827) compared with DAPT ≤1 year, which was primarily caused by the lower all-cause mortality (0.1% vs. 2.6%; HR 0.031, 95%CI 0.004-0.236). Risks of cardiac death (0.1% vs. 1.5%; HR 0.051, 95%CI 0.006-0.416) and definite/probable ST (0.3% vs. 1.1%; HR 0.218, 95%CI 0.052-0.917) were also lower in patients received DAPT>1 year than those received DAPT ≤ 1 year. No difference was found between the two groups in terms of BARC type 2, 3, or 5 bleeding (5.3% vs. 4.1%; HR 1.088, 95%CI 0.650-1.821). Conclusions: In patients with stable CAD and diabetes who were event-free at 1 year after PCI with DES, prolonged DAPT (>1 year) provides a substantial reduction in ischemic cardiovascular events, including MACCE, all-cause mortality, cardiac mortality, and definite/probable ST, without increasing the clinically relevant bleeding risk compared with ≤ 1-year DAPT. Further well-designed, large-scale randomized trials are needed to verify the beneficial effect of prolonged DAPT in this population.
