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

Abstract

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.

Is the duration of dual antiplatelet therapy (DAPT) excessive in post-angioplasty in chronic coronary syndrome? Data from the France-PCI registry (2014–2019)

“…Only a few observational studies have looked at DAPT times and their clinical impact, but these data are prior to 2014, with different techniques and materials, or concern post-MI (11)(12)(13). The few observations made with similar but underpowered cohort also show a significant proportion of long DAPT, often beyond the recommended durations (14). These results confirm the poor adherence to clinical practice recommendations regarding the duration and composition of DAPT after coronary angioplasty in CCS.…”

A Case of Ticagrelor Resistance

“…Platelet inhibition is pivotal to reduce cardiovascular events in patients with coronary artery disease. Aspirin is the cornerstone treatment, but in this era of dual anti-platelet therapy (DAPT), the addition of a P2Y 12 inhibitor is recommended in acute coronary syndromes [1] . Large scale trials have seen a shift from clopidogrel to prasugrel for P2Y 12 inhibition in patients with ST-elevation myocardial infarction (STEMI) and to ticagrelor in non-ST-elevation MI (NSTEMI) [2] .…”