Benefit of Prolonged Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stent for Coronary Bifurcation Lesions

Jang, Woo Jin; Ahn, Sung Gyun; Song, Young Bin; Choi, Seung Hyuk; Chun, Woo Jung; Oh, Ju Hyeon; Cho, Sung Woo; Kim, Bum Sung; Yoon, Jung Han; Koo, Bon Kwon; Yu, Cheol Woong; Jang, Yang Soo; Tahk, Seung Jea; Kim, Hyo Soo; Gwon, Hyeon Cheol; Lee, Sung Yun; Hahn, Joo Yong

doi:10.1161/circinterventions.117.005849

Cited by 30 publications

(13 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous results from the Coronary Bifurcation Stenting (COBIS) II registries showed that the risk of all-cause death or MI was significantly lower in the DAPT >12 months group than in the DAPT ≤12 months group after PCI of bifurcation lesions with DESs, but this analysis primarily included non-LMCA lesions, and the proportion of early-generation DESs was higher than current-generation DESs. 25 Several studies have attempted to determine the optimal DAPT duration for second-generation DESs, balancing safety and efficacy. However, few studies have assessed the optimal duration of DAPT in patients with LMCA lesions or examined whether the prolonged use of DAPT is necessary when using second-generation DESs.…”

Section: Limitations and Future Clinical Applicationsmentioning

confidence: 99%

Optimal Duration for Dual Antiplatelet Therapy After Left Main Coronary Artery Stenting

Choi

Kim

Cho

et al. 2020

Circ J

View full text Add to dashboard Cite

Section: Limitations and Future Clinical Applicationsmentioning

confidence: 99%

Optimal Duration for Dual Antiplatelet Therapy After Left Main Coronary Artery Stenting

Choi

Kim

Cho

et al. 2020

Circ J

View full text Add to dashboard Cite

“…A previous study reported that the risk of all-cause death or MI was significantly lower in the ≥12-month DAPT group than in the <12-month DAPT group after PCI for bifurcation lesions using DES. 21 …”

Section: Discussionmentioning

confidence: 99%

Determinants and Clinical Outcomes of Extended Dual Antiplatelet Therapy over 3 Years after Drug-Eluting Stent Implantation: A Retrospective Analysis

et al. 2020

View full text Add to dashboard Cite

Purpose: Although current guidelines recommend the administration of dual antiplatelet therapy (DAPT) for up to 12 months after the implantation of a drug-eluting stent (DES), extended DAPT is frequently used in real-world practice. Materials and Methods: From the Korean Multicenter Angioplasty Team registry, we identified a total of 1414 patients who used DAPT for >3 years after DES implantation (extended-DAPT group) and conducted a landmark analysis at 36 months after the index procedure. We evaluated the determinants for and long-term outcomes of extended DAPT and compared the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as the composite of all-cause death, myocardial infarction, stent thrombosis, and stroke, between the extended-DAPT group and the guideline-DAPT group [DAPT <1 year after DES implantation (n=1273)]. Results: Multivariate analysis indicated the occurrence of acute coronary syndrome as the most significant clinical determinant of the use of extended DAPT. Bifurcation, stent diameter ≤3.0 mm, total stented length ≥28 mm, and use of first-generation DESs were also significant angiographic and procedural determinants. MACCE rates were similar between the extended-DAPT group and the guideline-DAPT group in crude analysis [hazard ratio (HR), 1.08; 95% confidence interval (CI), 0.69-1.68; p=0.739] and after propensity matching (HR, 1.22; 95% CI, 0.72-2.07; p=0.453). Major bleeding rates were comparable between the two groups. Conclusion: In patients undergoing percutaneous coronary intervention, indefinite use of DAPT does not show superior outcomes to those of guideline-DAPT. Major bleeding rates are also similar.

show abstract

“…However, restenosis or ST in the LM lesion could result in serious consequences and may post LM‐PCI patients could benefit from extended duration of dual antiplatelet therapy. Dual antiplatelet therapy beyond 1 year reduced major adverse events without increased bleeding events in complex lesion PCI compared to 1‐year duration of dual antiplatelet therapy . Risk models are available to determine the duration of dual antiplatelet therapy and obtain the maximum net clinical benefit but do not contain information whether patients post LM‐PCI should be on longer duration of therapy .…”

Section: Discussionmentioning

confidence: 99%

“…Dual antiplatelet therapy beyond 1 year reduced major adverse events without increased bleeding events in complex lesion PCI compared to 1-year duration of dual antiplatelet therapy. 40,41 Risk models are available to determine the duration of dual antiplatelet therapy and obtain the maximum net clinical benefit but do not contain information whether patients post LM-PCI should be on longer duration of therapy. 42,43 Further studies are required to elucidate the optimal stenting technique in LM-PCI and duration of antiplatelet therapy.…”

Section: Clinical Presentationmentioning

confidence: 99%

Transradial versus transfemoral percutaneous coronary intervention of left main disease: A systematic review and meta‐analysis of observational studies

Ando

Aoi

Ashraf

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives To assess the efficacy and safety of transradial (TR) versus transfemoral (TF) percutaneous coronary intervention (PCI) in left main (LM) lesion. Background TR‐PCI is the preferred approach compared with TF approach because of less bleeding risk. LM‐PCI is often challenging because of the anatomical complexity and uniqueness of supplying a large myocardium territory. We performed a systematic review and meta‐analysis to assess the safety and efficacy of TR‐PCI compared with TF‐PCI of the LM lesions. Methods A comprehensive literature search of PUBMED, EMBASE, and Cochrane database was conducted to identify studies that reported the comparable outcomes between both approaches. Odds ratio (OR) and 95% confidence interval (CI) was calculated using the Mantel–Haenszel method. Results A total of eight studies were included in the quantitative meta‐analysis. TR‐PCI resulted in lower bleeding risk (OR 0.31, 95%CI 0.18–0.52, P < 0.01, I2 = 0%) while maintaining similar procedural success rate, target lesion revascularization, myocardial infarction, stent thrombosis, and all‐cause mortality during the study follow‐up period. Conclusions TR‐PCI may achieve similar efficacy with decreased bleeding risk compared to TF‐PCI in LM lesions. When operator experience and anatomical complexity are favorable, TR approach is an attractive alternative access over TF approach in LM‐PCI.

show abstract

Benefit of Prolonged Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stent for Coronary Bifurcation Lesions

Abstract: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01642992.

Cited by 30 publications

References 23 publications

Optimal Duration for Dual Antiplatelet Therapy After Left Main Coronary Artery Stenting

Optimal Duration for Dual Antiplatelet Therapy After Left Main Coronary Artery Stenting

Determinants and Clinical Outcomes of Extended Dual Antiplatelet Therapy over 3 Years after Drug-Eluting Stent Implantation: A Retrospective Analysis

Transradial versus transfemoral percutaneous coronary intervention of left main disease: A systematic review and meta‐analysis of observational studies

Contact Info

Product

Resources

About