Determinants and Clinical Outcomes of Extended Dual Antiplatelet Therapy over 3 Years after Drug-Eluting Stent Implantation: A Retrospective Analysis
10.3349/ymj.2020.61.7.597
- Author:
Oh-Hyun LEE
1
;
Byeong-Keuk KIM
;
Sung-Jin HONG
;
Seunghwan KIM
;
Chul-Min AHN
;
Dong-Ho SHIN
;
Jung-Sun KIM
;
Tae Soo KANG
;
Young-Guk KO
;
Donghoon CHOI
;
Myeong-Ki HONG
;
Yangsoo JANG
Author Information
1. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Publication Type:Original Article
- From:Yonsei Medical Journal
2020;61(7):597-605
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Although current guidelines recommend the administration of dual antiplatelet therapy (DAPT) for up to 12 months after the implantation of a drug-eluting stent (DES), extended DAPT is frequently used in real-world practice.
Materials and Methods:From the Korean Multicenter Angioplasty Team registry, we identified a total of 1414 patients who used DAPT for >3 years after DES implantation (extended-DAPT group) and conducted a landmark analysis at 36 months after the index procedure. We evaluated the determinants for and long-term outcomes of extended DAPT and compared the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as the composite of all-cause death, myocardial infarction, stent thrombosis, and stroke, between the extended-DAPT group and the guideline-DAPT group [DAPT <1 year after DES implantation (n=1273)].
Results:Multivariate analysis indicated the occurrence of acute coronary syndrome as the most significant clinical determinant of the use of extended DAPT. Bifurcation, stent diameter ≤3.0 mm, total stented length ≥28 mm, and use of first-generation DESs were also significant angiographic and procedural determinants. MACCE rates were similar between the extended-DAPT group and the guideline-DAPT group in crude analysis [hazard ratio (HR), 1.08; 95% confidence interval (CI), 0.69–1.68; p=0.739] and after propensity matching (HR, 1.22; 95% CI, 0.72–2.07; p=0.453). Major bleeding rates were comparable between the two groups.
Conclusion:In patients undergoing percutaneous coronary intervention, indefinite use of DAPT does not show superior outcomes to those of guideline-DAPT. Major bleeding rates are also similar.
