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Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet Therapy After Coronary Stenting

Authors
 Tullio Palmerini  ;  Letizia Bacchi Reggiani  ;  Diego Della Riva  ;  Mattia Romanello  ;  Fausto Feres  ;  Alexandre Abizaid  ;  Martine Gilard  ;  Marie-Claude Morice  ;  Marco Valgimigli  ;  Myeong-Ki Hong  ;  Byeong-Keuk Kim  ;  Yangsoo Jang  ;  Hyo-Soo Kim  ;  Kyung Woo Park  ;  Antonio Colombo  ;  Alaide Chieffo  ;  Jung-Min Ahn  ;  Seung-Jung Park  ;  Stefanie Schüpke  ;  Adnan Kastrati  ;  Gilles Montalescot  ;  Philippe Gabriel Steg  ;  Abdourahmane Diallo  ;  Eric Vicaut  ;  Gerard Helft  ;  Giuseppe Biondi-Zoccai  ;  Bo Xu  ;  Yaling Han  ;  Philippe Genereux  ;  Deepak L. Bhatt  ;  Gregg W. Stone 
Citation
 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol.69(16) : 2011-2022, 2017 
Journal Title
 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 
ISSN
 0735-1097 
Issue Date
2017
MeSH
Drug-Eluting Stents ; Hemorrhage/chemically induced* ; Hemorrhage/mortality ; Humans ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors/administration & dosage ; Platelet Aggregation Inhibitors/adverse effects* ; Postoperative Complications/chemically induced* ; Postoperative Complications/mortality ; Randomized Controlled Trials as Topic
Keywords
drug-eluting stent ; dual antiplatelet therapy ; mortality
Abstract
BACKGROUND: Although some randomized controlled trials (RCTs) and meta-analyses have suggested that prolonged dual-antiplatelet therapy (DAPT) may be associated with increased mortality, the mechanistic underpinnings of this association remain unclear. OBJECTIVES: The aim of this study was to analyze the associations among bleeding, mortality, and DAPT duration after drug-eluting stent implantation in a meta-analysis of RCTs. METHODS: RCTs comparing different DAPT durations after drug-eluting stent placement were sought through the MEDLINE, Embase, and Cochrane databases and the proceedings of international meetings. Deaths were considered possibly bleeding related if occurring within 1 year of the episodes of bleeding. Primary analysis was by intention-to-treat. Secondary analysis was performed in a modified intention-to-treat population in which events occurring when all patients were on DAPT were excluded. RESULTS: Individual patient data were obtained for 6 RCTs, and aggregate data were available for 12 RCTs. Patients with bleeding had significantly higher rates of mortality compared with those without, and in a time-adjusted multivariate analysis, bleeding was an independent predictor of mortality occurring within 1 year of the bleeding episode (hazard ratio: 6.93; 95% confidence interval: 4.53 to 10.60; p < 0.0001). Shorter DAPT was associated with lower rates of all-cause death compared with longer DAPT (hazard ratio: 0.85; 95% confidence interval: 0.73 to 1.00; p = 0.05), which was driven by lower rates of bleeding-related deaths with shorter DAPT compared with prolonged DAPT (hazard ratio: 0.65; 95% confidence interval: 0.43 to 0.99; p = 0.04). Mortality unrelated to bleeding was comparable between the 2 groups. Similar results were apparent in the modified intention-to-treat population. CONCLUSIONS: Bleeding was strongly associated with the occurrence of mortality within 1 year after the bleeding event. Shorter compared with longer DAPT was associated with lower risk for bleeding-related death, a finding that may underlie the lower all-cause mortality with shorter DAPT in the RCTs of different DAPT durations after DES.
Full Text
http://www.sciencedirect.com/science/article/pii/S0735109717306964
DOI
10.1016/j.jacc.2017.02.029.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154418
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