Abstract
Background: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been established yet. The objectives of this study were to evaluate the optimal duration of DAPT after the DES implantation. Methods: From three randomized controlled trials investigating DAPT duration after coronary stent implantation, we evaluated the clinical outcomes of short-term (6 months or less) DAPT compared with prolonged DAPT (12 months or more) in 1661 DES-treated pairs matched by propensity scores. At follow-up of 1 year, net adverse clinical event (NACE) was defined as cardiac death, myocardial infarction, target vessel revascularization, definite/probable stent thrombosis, or thrombolysis in myocardial infarction major bleeding. Results: Short-term DAPT as compared with prolonged DAPT was not associated with 1-year NACEs after DES implantation [hazard ratio (HR) 1.068, 95 % confidence interval (CI) 0.787–1.450, p = 0.671]. Predictors for NACEs were old age (>75 years), hypertension, diabetes mellitus, renal dysfunction (serum creatinine ≥2.0 mg/dL), and multi-vessel disease. The DAPT strategy differentially contributed to the occurrence of NACEs according to the risk burden (p for interaction <0.001). In patients with low risk for NACEs, bleeding events were less in short-term DAPT than in prolonged DAPT (HR 0.332, 95 % CI 0.130–0.849, p = 0.021) (p for interaction = 0.098). Meanwhile, short-term DAPT was associated with more ischemic events that included cardiac death, myocardial infarction, target vessel revascularization, or definite/probable stent thrombosis (HR 2.164, 95 % CI 1.340–3.494, p = 0.002) (p for interaction <0.001) in patients with high risk for NACEs. Conclusion: One-year clinical outcomes of DAPT after DES implantation depended on the burden of cardiovascular risk.
| Original language | English |
|---|---|
| Pages (from-to) | 165-173 |
| Number of pages | 9 |
| Journal | Clinical Research in Cardiology |
| Volume | 106 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2017 Mar 1 |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
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Clinical outcomes of dual antiplatelet therapy after implantation of drug-eluting stents in patients with different cardiovascular risk factors. / Lee, Seung Yul; Hong, Myeongki; Shin, Dong Ho; Kim, Jung Sun; Kim, Byeong Keuk; Ko, Young Guk; Choi, Donghoon; Jang, Yangsoo; Kim, Hyo Soo; Valgimigli, Marco; Palmerini, Tullio; Stone, Gregg W.
In: Clinical Research in Cardiology, Vol. 106, No. 3, 01.03.2017, p. 165-173.Research output: Contribution to journal › Article
TY - JOUR
T1 - Clinical outcomes of dual antiplatelet therapy after implantation of drug-eluting stents in patients with different cardiovascular risk factors
AU - Lee, Seung Yul
AU - Hong, Myeongki
AU - Shin, Dong Ho
AU - Kim, Jung Sun
AU - Kim, Byeong Keuk
AU - Ko, Young Guk
AU - Choi, Donghoon
AU - Jang, Yangsoo
AU - Kim, Hyo Soo
AU - Valgimigli, Marco
AU - Palmerini, Tullio
AU - Stone, Gregg W.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been established yet. The objectives of this study were to evaluate the optimal duration of DAPT after the DES implantation. Methods: From three randomized controlled trials investigating DAPT duration after coronary stent implantation, we evaluated the clinical outcomes of short-term (6 months or less) DAPT compared with prolonged DAPT (12 months or more) in 1661 DES-treated pairs matched by propensity scores. At follow-up of 1 year, net adverse clinical event (NACE) was defined as cardiac death, myocardial infarction, target vessel revascularization, definite/probable stent thrombosis, or thrombolysis in myocardial infarction major bleeding. Results: Short-term DAPT as compared with prolonged DAPT was not associated with 1-year NACEs after DES implantation [hazard ratio (HR) 1.068, 95 % confidence interval (CI) 0.787–1.450, p = 0.671]. Predictors for NACEs were old age (>75 years), hypertension, diabetes mellitus, renal dysfunction (serum creatinine ≥2.0 mg/dL), and multi-vessel disease. The DAPT strategy differentially contributed to the occurrence of NACEs according to the risk burden (p for interaction <0.001). In patients with low risk for NACEs, bleeding events were less in short-term DAPT than in prolonged DAPT (HR 0.332, 95 % CI 0.130–0.849, p = 0.021) (p for interaction = 0.098). Meanwhile, short-term DAPT was associated with more ischemic events that included cardiac death, myocardial infarction, target vessel revascularization, or definite/probable stent thrombosis (HR 2.164, 95 % CI 1.340–3.494, p = 0.002) (p for interaction <0.001) in patients with high risk for NACEs. Conclusion: One-year clinical outcomes of DAPT after DES implantation depended on the burden of cardiovascular risk.
AB - Background: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been established yet. The objectives of this study were to evaluate the optimal duration of DAPT after the DES implantation. Methods: From three randomized controlled trials investigating DAPT duration after coronary stent implantation, we evaluated the clinical outcomes of short-term (6 months or less) DAPT compared with prolonged DAPT (12 months or more) in 1661 DES-treated pairs matched by propensity scores. At follow-up of 1 year, net adverse clinical event (NACE) was defined as cardiac death, myocardial infarction, target vessel revascularization, definite/probable stent thrombosis, or thrombolysis in myocardial infarction major bleeding. Results: Short-term DAPT as compared with prolonged DAPT was not associated with 1-year NACEs after DES implantation [hazard ratio (HR) 1.068, 95 % confidence interval (CI) 0.787–1.450, p = 0.671]. Predictors for NACEs were old age (>75 years), hypertension, diabetes mellitus, renal dysfunction (serum creatinine ≥2.0 mg/dL), and multi-vessel disease. The DAPT strategy differentially contributed to the occurrence of NACEs according to the risk burden (p for interaction <0.001). In patients with low risk for NACEs, bleeding events were less in short-term DAPT than in prolonged DAPT (HR 0.332, 95 % CI 0.130–0.849, p = 0.021) (p for interaction = 0.098). Meanwhile, short-term DAPT was associated with more ischemic events that included cardiac death, myocardial infarction, target vessel revascularization, or definite/probable stent thrombosis (HR 2.164, 95 % CI 1.340–3.494, p = 0.002) (p for interaction <0.001) in patients with high risk for NACEs. Conclusion: One-year clinical outcomes of DAPT after DES implantation depended on the burden of cardiovascular risk.
UR - http://www.scopus.com/inward/record.url?scp=84986253427&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84986253427&partnerID=8YFLogxK
U2 - 10.1007/s00392-016-1035-4
DO - 10.1007/s00392-016-1035-4
M3 - Article
C2 - 27631821
AN - SCOPUS:84986253427
VL - 106
SP - 165
EP - 173
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
SN - 1861-0684
IS - 3
ER -