Optimal duration for dual antiplatelet therapy after left main coronary artery stenting

Jungho Choi, In Soo Kim, Sungsoo Cho, Jung Sun Kim, Sung Jin Hong, Dong Ho Shin, Chul Min Ahn, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Myeong Ki Hong, Yangsoo Jang

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Coronary interventions using drug-eluting stents (DESs) of left main coronary artery (LMCA) lesions have shown favorable clinical outcomes. However, duration of dual antiplatelet therapy (DAPT) after LMCA interventions has not yet been investigated. Methods and Results: From a multicenter Korean Multicenter Angioplasty Team (KOMATE) registry, 1,004 patients who received DES implantations for LMCA lesions and did not experience major adverse cardiovascular events (including major bleeding) for 1 year after coronary intervention were analyzed. Patients were divided into 2 groups; DAPT ≤12 (n=503) and >12 months (n=501). The primary endpoint was number of net clinical adverse events (NACEs), composite of cardiac deaths, myocardial infarctions, stent thrombosis and major bleeding events. During a 4.5-year follow-up period after LMCA interventions, the DAPT >12 months group showed a lower NACE rate than the DAPT ≤12 months group (adjusted-HR 0.53 [0.29–0.99], P=0.045). For patients who maintained DAPT >12 months, rate of cardiac deaths, myocardial infarctions, and stent thrombosis events were lower than in patients who had DAPT ≤12 months (adjusted-HR 0.35 [0.17–0.73], P=0.005) without increased major bleeding (P=0.402). Conclusions: For patients who can continue DAPT without major bleeding events, prolonged DAPT (>12 months) after LMCA stenting demonstrated better long-term efficacy outcomes than DAPT ≤12 months with comparable safety.

Original languageEnglish
Pages (from-to)59-68
Number of pages10
JournalCirculation Journal
Volume85
Issue number1
DOIs
Publication statusPublished - 2021 Jan

Bibliographical note

Funding Information:
This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science & ICT (2017M3A9E9073585), by a grant for the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI20C1566) and the Cardiovascular Research Center (Seoul, Korea).

Publisher Copyright:
© 2021 Japanese Circulation Society. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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