Long-term dual antiplatelet therapy significantly reduced major adverse cardiac events compared with short-term therapy in patients undergoing complex PCI (adjusted HR 0.56; 95% CI 0.35-0.89).
Meta-Analysis (n=9,577)
Yes
Does long-term (≥12 months) DAPT compared to short-term (3 or 6 months) DAPT reduce major adverse cardiac events in patients undergoing complex PCI?
Long-term DAPT (≥12 months) significantly reduces major adverse cardiac events compared to short-term DAPT in patients undergoing complex PCI, supporting the tailoring of DAPT duration based on procedural complexity.
Effect estimate: adjusted HR 0.56 (95% CI 0.35-0.89)
p-value: pinteraction = 0.01
BACKGROUND: Optimal upfront dual antiplatelet therapy (DAPT) duration after complex percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remains unclear. OBJECTIVES: This study investigated the efficacy and safety of long-term (≥12 months) versus short-term (3 or 6 months) DAPT with aspirin and clopidogrel according to PCI complexity. METHODS: The authors pooled patient-level data from 6 randomized controlled trials investigating DAPT durations after PCI. Complex PCI was defined as having at least 1 of the following features: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, or chronic total occlusion. The primary efficacy endpoint was major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, or stent thrombosis. The primary safety endpoint was major bleeding. Intention-to-treat was the primary analytic approach. RESULTS: Of 9,577 patients included in the pooled dataset for whom procedural variables were available, 1,680 (17.5%) underwent complex PCI. Overall, 85% of patients received new-generation DES. At a median follow-up time of 392 days (interquartile range: 366 to 710 days), patients who underwent complex PCI had a higher risk of MACE (adjusted hazard ratio HR: 1.98; 95% confidence interval CI: 1.50 to 2.60; p < 0.0001). Compared with short-term DAPT, long-term DAPT yielded significant reductions in MACE in the complex PCI group (adjusted HR: 0.56; 95% CI: 0.35 to 0.89) versus the noncomplex PCI group (adjusted HR: 1.01; 95% CI: 0.75 to 1.35; p CONCLUSIONS: Alongside other established clinical risk factors, procedural complexity is an important parameter to take into account in tailoring upfront duration of DAPT.
“By using an anatomic risk-stratification scheme, . . . it sounds like they've been more successful in identifying a high-risk population where the risk-benefit ratio favors longer-duration therapy.”
Giustino et al. (Sun,) conducted a meta-analysis in Complex percutaneous coronary intervention (PCI) (n=9,577). Long-term dual antiplatelet therapy (DAPT) with aspirin and clopidogrel vs. Short-term (3 or 6 months) DAPT was evaluated on Major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, or stent thrombosis (adjusted HR 0.56, 95% CI 0.35-0.89, p=pinteraction = 0.01). Long-term dual antiplatelet therapy significantly reduced major adverse cardiac events compared with short-term therapy in patients undergoing complex PCI (adjusted HR 0.56; 95% CI 0.35-0.89).