Seung-Yul Lee1, Myeong-Ki Hong2, Dong-Ho Shin1, Jung-Sun Kim1, Byeong-Keuk Kim1, Young-Guk Ko1, Donghoon Choi1, Yangsoo Jang1, Hyo-Soo Kim1, Marco Valgimigli1, Antonio Colombo1, Martine Gilard1, Tullio Palmerini1, Gregg W Stone1. 1. From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.). 2. From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.). mkhong61@yuhs.ac.
Abstract
BACKGROUND: There is general agreement that the optimal duration of dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents should be individualized. We hypothesized that the extent of coronary artery disease may affect the clinical outcomes of DAPT. METHODS AND RESULTS: We pooled patient-level data from 5 large, randomized trials comparing short-term DAPT with prolonged therapy. From the data, we identified 5476 patients who received newer-generation drug-eluting stents. Net adverse clinical event (NACE) was defined as a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding. At 1 year, NACE had occurred in 171 patients (3.1%). Independent predictors of NACE were older age (>65 years), sex, presence of diabetes mellitus, left ventricular dysfunction (ejection fraction <40%), and angiographic multivessel disease. Multivessel disease and DAPT duration were significantly associated with NACE (P for interaction=0.002); the association was driven by the greater occurrence of myocardial infarction in patients with multivessel disease. In patients with multivessel disease, 6-month DAPT (versus 12-month DAPT) was associated with a higher incidence of myocardial infarction (adjusted hazard ratio=2.748; 95% confidence interval=1.375-5.491; P=0.004), compared with patients with single-vessel disease (P for interaction=0.001). CONCLUSIONS: In patients treated with newer-generation drug-eluting stents, a significant interaction between DAPT strategy and multivessel disease was found regarding the occurrence of NACE at 1 year. Among adverse events, myocardial infarction was more frequent in 6-month DAPT than in 12-month DAPT in patients with multivessel disease.
BACKGROUND: There is general agreement that the optimal duration of dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents should be individualized. We hypothesized that the extent of coronary artery disease may affect the clinical outcomes of DAPT. METHODS AND RESULTS: We pooled patient-level data from 5 large, randomized trials comparing short-term DAPT with prolonged therapy. From the data, we identified 5476 patients who received newer-generation drug-eluting stents. Net adverse clinical event (NACE) was defined as a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding. At 1 year, NACE had occurred in 171 patients (3.1%). Independent predictors of NACE were older age (>65 years), sex, presence of diabetes mellitus, left ventricular dysfunction (ejection fraction <40%), and angiographic multivessel disease. Multivessel disease and DAPT duration were significantly associated with NACE (P for interaction=0.002); the association was driven by the greater occurrence of myocardial infarction in patients with multivessel disease. In patients with multivessel disease, 6-month DAPT (versus 12-month DAPT) was associated with a higher incidence of myocardial infarction (adjusted hazard ratio=2.748; 95% confidence interval=1.375-5.491; P=0.004), compared with patients with single-vessel disease (P for interaction=0.001). CONCLUSIONS: In patients treated with newer-generation drug-eluting stents, a significant interaction between DAPT strategy and multivessel disease was found regarding the occurrence of NACE at 1 year. Among adverse events, myocardial infarction was more frequent in 6-month DAPT than in 12-month DAPT in patients with multivessel disease.
Authors: Wayne Batchelor; David E Kandzari; Scott Davis; Luis Tami; John C Wang; Islam Othman; Osvaldo S Gigliotti; Amir Haghighat; Sarabjeet Singh; Mario Lopez; Gregory Giugliano; Phillip A Horwitz; Jaya Chandrasekhar; Paul Underwood; Craig A Thompson; Roxana Mehran Journal: JAMA Cardiol Date: 2017-12-01 Impact factor: 14.676