Doo Sun Sim1, Myung Ho Jeong2, Hyo Soo Kim3, Hyeon Cheol Gwon4, Ki Bae Seung5, Seung Woon Rha6, Shung Chull Chae7, Chong Jin Kim8, Kwang Soo Cha9, Jong Seon Park10, Jung Han Yoon11, Jei Keon Chae12, Seung Jae Joo13, Dong Ju Choi14, Seung Ho Hur15, In Whan Seong16, Myeong Chan Cho17, Doo Il Kim18, Seok Kyu Oh19, Tae Hoon Ahn20, Jin Yong Hwang21. 1. Chonnam National University Hospital, Gwanjgu, Republic of Korea. 2. Chonnam National University Hospital, Gwanjgu, Republic of Korea. Electronic address: myungho@chollian.net. 3. Seoul National University Hospital, Seoul, Republic of Korea. 4. Sungkyunkwan University, Seoul Samsung Medical Center, Seoul, Republic of Korea. 5. The Catholic University of Korea, Seoul, Republic of Korea. 6. Korea University Guro Hospital, Seoul, Republic of Korea. 7. Kyungpook National University Hospital, Daegu, Republic of Korea. 8. Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea. 9. Pusan National University Hospital, Busan, Republic of Korea. 10. Yeungnam University Hospital, Daegu, Republic of Korea. 11. Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea. 12. Chunbuk National University Hospital, Jeonju, Republic of Korea. 13. Jeju National University Hospital, Jeju, Republic of Korea. 14. Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 15. Keimyung University Dongsan Medical Center, Daegu, Republic of Korea. 16. Chungnam National University Hospital, Daejeon, Republic of Korea. 17. Chungbuk National University Hospital, Cheongju, Republic of Korea. 18. Inje University Haeundae Paik Hospital, Busan, Republic of Korea. 19. Wonkwang University Hospital, Iksan, Republic of Korea. 20. Gachon University Gil Medical Center, Incheon, Republic of Korea. 21. Kyungsang National University Hospital, Jinju, Republic of Korea.
Abstract
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after acute coronary syndrome remains uncertain. This study investigated the benefit of DAPT beyond 12 months after drug-eluting stents (DES) for acute myocardial infarction (MI). METHODS: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 6199 patients treated with DAPT for 12 months after DES (second-generation DES 98%) without ischemic or bleeding events were analyzed. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), a composite of death from any cause, MI, or ischemic stroke during the period from 12 to 24 months. RESULTS: After adjustment using inverse probability of treatment weighting, patients who received DAPT beyond 12 months (n=4795), compared to patients treated with 12-month DAPT (n=1404), had a similar incidence of MACCE (1.3% vs. 1.0%, HR: 1.32, 95% CI: 0.71-2.45, p=0.378). The 2 groups did not differ significantly in the rates of death (0.1% vs. 0.1%), MI (0.8% vs.0.6%), stent thrombosis (0.1% vs. 0.2%), ischemic stroke (0.4% vs. 0.2%), and major bleeding (0.1% vs. 0.1%). The rate of net adverse clinical events was 1.4% with DAPT beyond 12 months and 1.1% with 12-month DAPT (p=0.466). CONCLUSIONS: DAPT beyond 12 months, as compared with 12-month DAPT, in real-world patients with acute MI treated predominantly with second-generation DES did not reduce the risk of MACCE. The rates of major bleeding and net adverse clinical events did not differ significantly between the 2 treatments.
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after acute coronary syndrome remains uncertain. This study investigated the benefit of DAPT beyond 12 months after drug-eluting stents (DES) for acute myocardial infarction (MI). METHODS: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 6199 patients treated with DAPT for 12 months after DES (second-generation DES 98%) without ischemic or bleeding events were analyzed. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), a composite of death from any cause, MI, or ischemic stroke during the period from 12 to 24 months. RESULTS: After adjustment using inverse probability of treatment weighting, patients who received DAPT beyond 12 months (n=4795), compared to patients treated with 12-month DAPT (n=1404), had a similar incidence of MACCE (1.3% vs. 1.0%, HR: 1.32, 95% CI: 0.71-2.45, p=0.378). The 2 groups did not differ significantly in the rates of death (0.1% vs. 0.1%), MI (0.8% vs.0.6%), stent thrombosis (0.1% vs. 0.2%), ischemic stroke (0.4% vs. 0.2%), and major bleeding (0.1% vs. 0.1%). The rate of net adverse clinical events was 1.4% with DAPT beyond 12 months and 1.1% with 12-month DAPT (p=0.466). CONCLUSIONS: DAPT beyond 12 months, as compared with 12-month DAPT, in real-world patients with acute MI treated predominantly with second-generation DES did not reduce the risk of MACCE. The rates of major bleeding and net adverse clinical events did not differ significantly between the 2 treatments.