Why carry out this study?
|
It is unclear whether dual antiplatelet agent therapy (DAPT) should be continued for patients after first-generation coronary drug-eluting stent (DES) implantation. |
This study roughly approximates the effect of continued DAPT after first-generation DES implantation. |
What was learned from the study?
|
Long-term DAPT use significantly reduced the risk of stent thrombosis but increased the risk of major bleeding. |
The decision to continue DAPT should be made on a patient-by-patient basis. |
There was no marked difference between the number of benefits from reduced stent thrombosis and the number of risks from major bleeding. |
Introduction
Methods
Study Design and Patients
Definitions
Statistical Analysis
Results
All patients | 567 | ||
DAPT | 344 | OAC | 52 |
clopidogrel | 131 | OAC + DAPT | 13 |
ticlopidine | 213 | OAC + SAPT | 34 |
SAPT | 171 | OAC only | 5 |
aspirine | 148 | Warfarin | 47 |
clopidogrel | 17 | DOAC | 5 |
Mean TTR of warfarin use (PT-INR 1.60–2.59) | 61.6% | ||
Patients with TTR ≧ 60% | 61.2% |
Baseline characteristics | ||||
---|---|---|---|---|
SAPT (n = 130) | DAPT (n = 255) | OAC (n = 46) | p | |
Age (years) | 67.7 ± 9.4 | 65.6 ± 10.1 | 70.8 ± 9.2 | 0.0004 |
Male | 128 (74.9) | 269 (78.2) | 35 (67.3) | 0.22 |
Diabetes mellitus | 57(33.3) | 123 (35.8) | 19 (36.5) | 0.84 |
Dyslipidemia | 77 (45.0) | 152 (44.2) | 22 (42.3) | 0.94 |
Hypertension | 86 (50.3) | 157 (45.6) | 29 (55.8) | 0.3 |
Current smoker | 28 (16.4) | 71 (20.6) | 6 (11.5) | 0.18 |
Hemodialysis | 4 (2.3) | 8 (2.3) | 3 (5.8) | 0.43 |
History of MI | 34 (19.9) | 80 (23.3) | 14 (26.9) | 0.51 |
Previous PCI | 34 (19.9) | 72 (20.9) | 17 (32.7) | 0.15 |
Post CABG | 10 (5.8) | 17 (4.9) | 5 (9.6) | 0.44 |
Restenosis lesion | 10 (5.8) | 23 (6.7) | 6 (11.5) | 0.41 |
Chronic total occlusion | 8 (4.7) | 15 (4.4) | 5 (9.6) | 0.33 |
Acute coronary syndrome | 61 (35.7) | 154 (44.8) | 19 (36.5) | 0.11 |
Bifurcation lesion | 24 (14.0) | 58 (16.9) | 7 (13.5) | 0.63 |
LMCA | 6 (3.5) | 15 (4.4) | 1 (1.9) | 0.63 |
RCA | 40 (23.4) | 83 (24.1) | 10 (19.2) | 0.73 |
LAD | 101 (59.1) | 209 (60.8) | 33 (63.5) | 0.84 |
LCx | 29 (17.0) | 56 (16.3) | 8 (15.4) | 0.96 |
Bypass | 1 (0.6) | 3 (0.9) | 1 (1.9) | 0.71 |
Multivessel | 25 (14.6) | 62 (18.0) | 8 (15.4) | 0.59 |
Number of stents used | 1.42 ± 0.58 | 1.44 ± 0.64 | 1.40 ± 0.57 | 0.88 |
Stent size (mm) | 2.96 ± 0.37 | 2.98 ± 0.36 | 2.96 ± 0.38 | 0.84 |
Length of stents used (mm) | 32.7 ± 15.2 | 33.0 ± 17.1 | 30.5 ± 15.7 | 0.58 |
Antithrombotic therapy at 5 years | p | |||
---|---|---|---|---|
SAPT (n = 171) | DAPT (n = 344) | OAC (n = 52) | ||
Definite/probable ST | 4.5% | 1.1% | 0.0% | 0.044 |
Major bleeding | 3.7% | 6.0% | 18.6% | 0.0043 |
All-cause death | 12.8% | 10.3% | 19.2% | 0.29 |
Cardiac death | 4.7% | 5.5% | 3.1% | 0.98 |
Non-fatal AMI | 7.4% | 7.6% | 3.7% | 0.91 |
TLR | 9.4% | 7.9% | 4.9% | 0.84 |
ST | Major bleeding | |||||
---|---|---|---|---|---|---|
HR | CI | p | HR | CI | p | |
DAPT/SAPT | 0.24 | 0.05–0.89 | 0.034 | 1.72 | 0.69–5.21 | 0.26 |
OAC/SAPT | - | 0–1.31 | 0.081 | 5.31 | 1.69–17.95 | 0.0048 |
OAC/DAPT | - | 0–6.58 | 0.38 | 3.08 | 1.20–7.09 | 0.022 |
Adjusted by age | ||||||
---|---|---|---|---|---|---|
ST | Major bleeding | |||||
HR | CI | p | HR | CI | p | |
DAPT/SAPT | 0.21 | 0.04–0.81 | 0.024 | 1.85 | 0.74–5.60 | 0.20 |
OAC/SAPT | – | 0–1.51 | 0.10 | 4.24 | 1.35–14.38 | 0.014 |
OAC/DAPT | – | 0–8.77 | 0.44 | 2.29 | 0.88–5.31 | 0.084 |
Stent thrombosis | ||
---|---|---|
Antithrombotic medications at year 5 | At the time of the event | |
SAPT 6 | ⇒ | SAPT 6 |
DAPT 3 | ⇒ | DAPT 1, SAPT 1, OAC + SAPT 1 |
Major bleeding | ||
---|---|---|
Antithrombotic medications at year 5 | At the time of the event | |
SAPT 5 | ⇒ | SAPT 5 |
DAPT 18 | ⇒ | DAPT 12, SAPT 4, OAC + SAPT 2 |
OAC + DAPT 2, OAC + SAPT5 | ⇒ | OAC + DAPT 1, OAC + SAPT 4, OAC alone 1, SAPT 1 |