Efficacy and safety of guideline-recommended risk score-directed dual antiplatelet therapy after 2nd-generation drug-eluting stents

Ji Yong Jang, Byoung Kwon Lee, Jung Sun Kim, Dong Ho Shin, Sung Jin Hong, Chul Min Ahn, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Myeong Ki Hong, Kyung Woo Park, Hyeon Cheol Gwon, Hyo Soo Kim, Hyuck Moon Kwon, Yangsoo Jang

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)161-168
Number of pages8
JournalCirculation Journal
Volume84
Issue number2
DOIs
Publication statusPublished - 2020

Bibliographical note

Funding 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

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