Background: Evaluate the safety and efficacy of guideline-recommended risk score-directed dual antiplatelet therapy (GD-DAPT) based on THE PRECISE-DAPT score after 2nd-generation drug-eluting stent (DES) implantation. Methods and Results: We analyzed 5,131 patients pooled from 4 clinical trials. Patients were divided into 3 groups according to current recommendations on the duration of DAPT and their actual DAPT duration: GD-DAPT (n=2,183), shorter DAPT (n=1,540), longer DAPT (n=1,408). The primary endpoint was the rate of net adverse clinical events (NACE) during the first 12 months. The secondary endpoints were ischemic or bleeding events. Overall, GD-DAPT did not affect NACE (1.2% vs. 1.2% for shorter DAPT and 1.7% for longer DAPT) or bleeding events (0.6% vs. 0.5% and 0.9%), and there were fewer ischemic events (2.8% vs. 4.4% and 4.0%, P=0.03) than with shorter DAPT. Especially in acute coronary syndrome (ACS) patients, GD-DAPT had fewer NACE (1.5% vs. 1.4% and 4.2%; P=0.006) and bleeding events (0.8% vs. 0.5% and 2.8%; P=0.001) than longer DAPT as well as fewer ischemic events (2.8% vs. 4.4% and 4.7%; P=0.03) than shorter DAPT. Conclusions: GD-DAPT did not affect NACE or bleeding events and reduced the number of ischemic events at 12 months compared with shorter DAPT. For ACS, GD-DAPT was associated with favorable outcomes compared with non-GD-DAPT. Therefore, GD-DAPT may optimize efficacy and safety.
Bibliographical noteFunding Information:
Funding/Support: This work was supported by a grant from the Korea Healthcare Technology Research & Development Project, Ministry for Health & Welfare, Republic of Korea [grant numbers A085136, HI15C1277], the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) [grant number 2017R1A2B2003191], and the Cardiovascular Research Centre, Seoul, Korea. No funder/sponsor had any role in the design and conduct of the study. Author Contributions: Jung-Sun Kim, MD and Ji-Yong Jang, MD had full access to all data in the study, and take responsibility for data integrity and data analysis accuracy. Study concept and design: All authors Acquisition of data: All authors Analysis and interpretation of data: All authors Drafting of the manuscript: Ji-Yong Jang, MD; Dong-Ho Shin, MD; Byoung-Kwon Lee, MD; and Jung-Sun Kim, MD Critical revision of the manuscript for important intellectual content: All authors Statistical analysis: Dong-Ho Shin, MD, MPH Study supervision: Yangsoo Jang, MD; Myeong-Ki Hong, MD.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine