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

Authors
 Choi, Jungho  ;  Kim, In-Soo  ;  Cho, Sungsoo  ;  Kim, Jung-Sun  ;  Hong, Sung-Jin  ;  Shin, Dong-Ho  ;  Ahn, Chul-Min  ;  Kim, Byeong-Keuk  ;  Ko, Young-Guk  ;  Choi, Donghoon  ;  Hong, Myeong-Ki  ;  Jang, Yangsoo 
Citation
 CIRCULATION JOURNAL, Vol.85(1) : 59-+, 2021-01 
Journal Title
 CIRCULATION JOURNAL 
ISSN
 1346-9843 
Issue Date
2021-01
Keywords
Dual antiplatelet therapy ; Duration ; Left main coronary artery disease ; Percutaneous coronary intervention
Abstract
Background: Coronary interventions using drug-eluting stents (DESs) of left main coronary artery (LMCA) lesions have shown favorable clinical outcomes. However, duration of dual antiplatelet therapy (DAPT) after LMCA interventions has not yet been investigated. Methods and Results: From a multicenter Korean Multicenter Angioplasty Team (KOMATE) registry, 1,004 patients who received DES implantations for LMCA lesions and did not experience major adverse cardiovascular events (including major bleeding) for 1 year after coronary intervention were analyzed. Patients were divided into 2 groups; DAPT <= 12 (n=503) and >12 months (n=501). The primary endpoint was number of net clinical adverse events (NACEs), composite of cardiac deaths, myocardial infarctions, stent thrombosis and major bleeding events. During a 4.5-year follow-up period after LMCA interventions, the DAPT >12 months group showed a lower NACE rate than the DAPT <= 12 months group (adjusted-HR 0.53 [0.29-0.99], P=0.045). For patients who maintained DAPT >12 months, rate of cardiac deaths, myocardial infarctions, and stent thrombosis events were lower than in patients who had DAPT <= 12 months (adjusted-HR 0.35 [0.17-0.73], P=0.005) without increased major bleeding (P=0.402). Conclusions: For patients who can continue DAPT without major bleeding events, prolonged DAPT (>12 months) after LMCA stenting demonstrated better long-term efficacy outcomes than DAPT <= 12 months with comparable safety.
DOI
10.1253/circj.CJ-20-0362
Appears in Collections:
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, In-Soo(김인수) ORCID logo https://orcid.org/0000-0003-2801-5514
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
Ahn, Chul-Min(안철민)
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
Choi, Jung Ho(최정호)
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/181856
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