Association between Duration of Dual Antiplatelet Therapy and Angiographic Multivessel Disease on Outcomes in Patients Treated with Newer-Generation Drug-Eluting Stents

Seung Yul Lee, Myeong Ki Hong, Dong Ho Shin, Jung Sun Kim, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Yangsoo Jang, Hyo Soo Kim, Marco Valgimigli, Antonio Colombo, Martine Gilard, Tullio Palmerini, Gregg W. Stone

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Abstract

Background-There is general agreement that the optimal duration of dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents should be individualized. We hypothesized that the extent of coronary artery disease may affect the clinical outcomes of DAPT. Methods and Results-We pooled patient-level data from 5 large, randomized trials comparing short-term DAPT with prolonged therapy. From the data, we identified 5476 patients who received newer-generation drug-eluting stents. Net adverse clinical event (NACE) was defined as a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding. At 1 year, NACE had occurred in 171 patients (3.1%). Independent predictors of NACE were older age (>65 years), sex, presence of diabetes mellitus, left ventricular dysfunction (ejection fraction <40%), and angiographic multivessel disease. Multivessel disease and DAPT duration were significantly associated with NACE (P for interaction=0.002); the association was driven by the greater occurrence of myocardial infarction in patients with multivessel disease. In patients with multivessel disease, 6-month DAPT (versus 12-month DAPT) was associated with a higher incidence of myocardial infarction (adjusted hazard ratio=2.748; 95% confidence interval=1.375-5.491; P=0.004), compared with patients with single-vessel disease (P for interaction=0.001). Conclusions-In patients treated with newer-generation drug-eluting stents, a significant interaction between DAPT strategy and multivessel disease was found regarding the occurrence of NACE at 1 year. Among adverse events, myocardial infarction was more frequent in 6-month DAPT than in 12-month DAPT in patients with multivessel disease.

Original languageEnglish
Article numbere004256
JournalCirculation: Cardiovascular Interventions
Volume9
Issue number11
DOIs
Publication statusPublished - 2016 Nov 1

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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