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Clinical outcomes of dual antiplatelet therapy after implantation of drug-eluting stents in patients with different cardiovascular risk factors

 Seung-Yul Lee  ;  Myeong-Ki Hong  ;  Dong-Ho Shin  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Yangsoo Jang  ;  Hyo-Soo Kim  ;  Marco Valgimigli  ;  Tullio Palmerini  ;  Gregg W. Stone 
 CLINICAL RESEARCH IN CARDIOLOGY, Vol.106(3) : 165-173, 2017 
Journal Title
Issue Date
Aged ; Aspirin/administration & dosage* ; Coronary Artery Disease/diagnosis ; Coronary Artery Disease/surgery* ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/prevention & control* ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Drug-Eluting Stents* ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents/pharmacology ; Incidence ; Male ; Middle Aged ; Myocardial Infarction/epidemiology ; Myocardial Infarction/prevention & control* ; Percutaneous Coronary Intervention* ; Platelet Aggregation Inhibitors/administration & dosage ; Republic of Korea/epidemiology ; Risk Factors ; Sirolimus/analogs & derivatives ; Sirolimus/pharmacology ; Ticlopidine/administration & dosage ; Ticlopidine/analogs & derivatives* ; Time Factors
Antiplatelet therapy ; Coronary artery disease ; Drug-eluting stent
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been established yet. The objectives of this study were to evaluate the optimal duration of DAPT after the DES implantation. METHODS: From three randomized controlled trials investigating DAPT duration after coronary stent implantation, we evaluated the clinical outcomes of short-term (6 months or less) DAPT compared with prolonged DAPT (12 months or more) in 1661 DES-treated pairs matched by propensity scores. At follow-up of 1 year, net adverse clinical event (NACE) was defined as cardiac death, myocardial infarction, target vessel revascularization, definite/probable stent thrombosis, or thrombolysis in myocardial infarction major bleeding. RESULTS: Short-term DAPT as compared with prolonged DAPT was not associated with 1-year NACEs after DES implantation [hazard ratio (HR) 1.068, 95 % confidence interval (CI) 0.787-1.450, p = 0.671]. Predictors for NACEs were old age (>75 years), hypertension, diabetes mellitus, renal dysfunction (serum creatinine ≥2.0 mg/dL), and multi-vessel disease. The DAPT strategy differentially contributed to the occurrence of NACEs according to the risk burden (p for interaction <0.001). In patients with low risk for NACEs, bleeding events were less in short-term DAPT than in prolonged DAPT (HR 0.332, 95 % CI 0.130-0.849, p = 0.021) (p for interaction = 0.098). Meanwhile, short-term DAPT was associated with more ischemic events that included cardiac death, myocardial infarction, target vessel revascularization, or definite/probable stent thrombosis (HR 2.164, 95 % CI 1.340-3.494, p = 0.002) (p for interaction <0.001) in patients with high risk for NACEs. CONCLUSION: One-year clinical outcomes of DAPT after DES implantation depended on the burden of cardiovascular risk.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shin, Dong Ho(신동호) ORCID logo https://orcid.org/0000-0002-7874-5542
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
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