Abstract
Objectives: This study sought to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent (DES) in elderly patients. Background: Qualified studies to evaluate the optimal duration of DAPT in elderly patients have been very limited. Methods: Using 6 randomized trials that compared short-term (≤6 months) and long-term (12 months) DAPT, individual participant data meta-analysis was performed in elderly patients (≥65 years of age). The primary study outcome was the 12-month risk of a composite of myocardial infarction, definite or probable stent thrombosis, or stroke. The major secondary outcome was the 12-month risk of major bleeding. Results: The primary outcome risk did not significantly differ between patients receiving short-term and long-term DAPT (hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.88 to 1.43; p = 0.3581) in the overall group of study participants. In subgroup analysis, a significant interaction between age and DAPT duration was observed for primary outcome risk (p for interaction = 0.0384). In the subset of younger patients (<65 years of age, n = 6,152), short-term DAPT was associated with higher risk of primary outcome (HR: 1.67; 95% CI: 1.14 to 2.44; p = 0.0082). In elderly patients (n = 5,319), however, the risk of primary outcome did not significantly differ between patients receiving short-term and long-term DAPT (HR: 0.84; 95% CI: 0.60 to 1.16; p = 0.2856). Short-term DAPT was associated with a significant reduction in major bleeding compared with long-term DAPT (HR: 0.50; 95% CI: 0.30 to 0.84; p = 0.0081) in the overall group, and particularly in elderly patients (HR: 0.46; 95% CI: 0.24-0.88; p = 0.0196). Conclusions: Short-term DAPT after new-generation DES implantation may be more beneficial in elderly patients than in younger patients.
| Original language | English |
|---|---|
| Pages (from-to) | 435-443 |
| Number of pages | 9 |
| Journal | JACC: Cardiovascular Interventions |
| Volume | 11 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 2018 Mar 12 |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
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Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients : A Meta-Analysis of Individual Participant Data From 6 Randomized Trials. / Lee, Seung Yul; Hong, Myeong Ki; Palmerini, Tullio; Kim, Hyo Soo; Valgimigli, Marco; Feres, Fausto; Colombo, Antonio; Gilard, Martine; Shin, Dong Ho; Kim, Jung Sun; Kim, Byeong Keuk; Ko, Young Guk; Choi, Donghoon; Jang, Yangsoo; Stone, Gregg W.
In: JACC: Cardiovascular Interventions, Vol. 11, No. 5, 12.03.2018, p. 435-443.Research output: Contribution to journal › Article
TY - JOUR
T1 - Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients
T2 - A Meta-Analysis of Individual Participant Data From 6 Randomized Trials
AU - Lee, Seung Yul
AU - Hong, Myeong Ki
AU - Palmerini, Tullio
AU - Kim, Hyo Soo
AU - Valgimigli, Marco
AU - Feres, Fausto
AU - Colombo, Antonio
AU - Gilard, Martine
AU - Shin, Dong Ho
AU - Kim, Jung Sun
AU - Kim, Byeong Keuk
AU - Ko, Young Guk
AU - Choi, Donghoon
AU - Jang, Yangsoo
AU - Stone, Gregg W.
PY - 2018/3/12
Y1 - 2018/3/12
N2 - Objectives: This study sought to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent (DES) in elderly patients. Background: Qualified studies to evaluate the optimal duration of DAPT in elderly patients have been very limited. Methods: Using 6 randomized trials that compared short-term (≤6 months) and long-term (12 months) DAPT, individual participant data meta-analysis was performed in elderly patients (≥65 years of age). The primary study outcome was the 12-month risk of a composite of myocardial infarction, definite or probable stent thrombosis, or stroke. The major secondary outcome was the 12-month risk of major bleeding. Results: The primary outcome risk did not significantly differ between patients receiving short-term and long-term DAPT (hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.88 to 1.43; p = 0.3581) in the overall group of study participants. In subgroup analysis, a significant interaction between age and DAPT duration was observed for primary outcome risk (p for interaction = 0.0384). In the subset of younger patients (<65 years of age, n = 6,152), short-term DAPT was associated with higher risk of primary outcome (HR: 1.67; 95% CI: 1.14 to 2.44; p = 0.0082). In elderly patients (n = 5,319), however, the risk of primary outcome did not significantly differ between patients receiving short-term and long-term DAPT (HR: 0.84; 95% CI: 0.60 to 1.16; p = 0.2856). Short-term DAPT was associated with a significant reduction in major bleeding compared with long-term DAPT (HR: 0.50; 95% CI: 0.30 to 0.84; p = 0.0081) in the overall group, and particularly in elderly patients (HR: 0.46; 95% CI: 0.24-0.88; p = 0.0196). Conclusions: Short-term DAPT after new-generation DES implantation may be more beneficial in elderly patients than in younger patients.
AB - Objectives: This study sought to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent (DES) in elderly patients. Background: Qualified studies to evaluate the optimal duration of DAPT in elderly patients have been very limited. Methods: Using 6 randomized trials that compared short-term (≤6 months) and long-term (12 months) DAPT, individual participant data meta-analysis was performed in elderly patients (≥65 years of age). The primary study outcome was the 12-month risk of a composite of myocardial infarction, definite or probable stent thrombosis, or stroke. The major secondary outcome was the 12-month risk of major bleeding. Results: The primary outcome risk did not significantly differ between patients receiving short-term and long-term DAPT (hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.88 to 1.43; p = 0.3581) in the overall group of study participants. In subgroup analysis, a significant interaction between age and DAPT duration was observed for primary outcome risk (p for interaction = 0.0384). In the subset of younger patients (<65 years of age, n = 6,152), short-term DAPT was associated with higher risk of primary outcome (HR: 1.67; 95% CI: 1.14 to 2.44; p = 0.0082). In elderly patients (n = 5,319), however, the risk of primary outcome did not significantly differ between patients receiving short-term and long-term DAPT (HR: 0.84; 95% CI: 0.60 to 1.16; p = 0.2856). Short-term DAPT was associated with a significant reduction in major bleeding compared with long-term DAPT (HR: 0.50; 95% CI: 0.30 to 0.84; p = 0.0081) in the overall group, and particularly in elderly patients (HR: 0.46; 95% CI: 0.24-0.88; p = 0.0196). Conclusions: Short-term DAPT after new-generation DES implantation may be more beneficial in elderly patients than in younger patients.
UR - http://www.scopus.com/inward/record.url?scp=85041994846&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85041994846&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2017.10.015
DO - 10.1016/j.jcin.2017.10.015
M3 - Article
C2 - 29454730
AN - SCOPUS:85041994846
VL - 11
SP - 435
EP - 443
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 5
ER -