Why the study?
Although recent guidelines generally favor shorter DAPT duration with second-generation drug-eluting stents, the effects on long-term outcomes in the wider population remained uncertain.
Does discontinuation of DAPT after 9 months reduce long-term adverse ischemic and bleeding events in patients who had PCI with second-generation drug-eluting stents?
Cohort (n=40,882)
Yes
Does discontinuation of DAPT after 9 months reduce long-term adverse ischemic and bleeding events in patients who had PCI with second-generation drug-eluting stents?
Hazard Ratio: 0.93 (95% CI 0.88–0.99)
Stopping DAPT after 9 months is associated with lower long-term risks of death, ischemic events, and bleeding compared to extending DAPT, supporting guidelines for shorter DAPT duration with second-generation drug-eluting stents.
May support shorter DAPT after 9 months post-PCI with second-generation stents; extends observational data but leaves open need for randomized confirmation.
Background Recent guidelines on dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention (PCI) balance the subsequent risks of major bleeding with ischemic events. Although generally favoring shorter DAPT duration with second-generation drug-eluting stents, the effects on long-term outcomes in the wider population are uncertain. Methods and Results We tracked all patients having PCI with second-generation drug-eluting stents in the Veterans Affairs Healthcare System between 2006 and 2016 for death, myocardial infarction, stroke, and major bleeding up to 13 years. We compared these outcomes with 4 DAPT durations of 1 to 5, 6 to 9, 10 to 12, and 13 to 18 months after the index PCI using hazard ratios (HRs) and 95% CIs from Cox proportional hazards models adjusted by inverse probability weighting. A total of 40 882 subjects with PCI were followed up for a median of 4.3 (25%-75%: 2.4-6.5) years. DAPT discontinuation was rare early after PCI (5.8% at 1-5 months and 6.3% at 6-9 months) but increased (19% and 44%) >9 months. The risk of cardiovascular and noncardiovascular death was higher (HR, 2.03-3.41) with DAPT discontinuation <9 months, likely reflecting premature cessation from factors related to early death. DAPT discontinuation after 9 months following PCI was associated with lower risks of death (HR, 0.93 [95% CI, 0.88-0.99]), cardiac death (HR, 0.79 [95% CI, 0.70-0.90]), myocardial infarction (HR, 0.75 [95% CI, 0.69-0.82]), and major bleeding (HR, 0.82 [95% CI, 0.74-0.91]). Results were similar with an index PCI for an acute coronary syndrome. Conclusions Stopping DAPT after 9 months is associated with lower long-term risks of adverse ischemic and bleeding events and supports recent guidelines of shorter duration DAPT after PCI with second-generation drug-eluting stents.
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Kinlay et al. (2023) conducted a cohort in Patients who underwent PCI with second-generation drug-eluting stents (n=40,882). Discontinuation of dual antiplatelet therapy (DAPT) after 9 months vs. Continuation of DAPT beyond 9 months was evaluated on All-cause death (comparing DAPT discontinuation vs continuation >9 to 12 months after PCI) (HR 0.93, 95% CI 0.88-0.99).
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