Practice Pattern and Prognostic Effect of Dual Antiplatelet Therapy for Left Main Coronary Artery Disease

The aim of this study was to investigate the practice pattern and long-term prognostic effect of dual antiplatelet therapy (DAPT) duration in patients undergoing percutaneous coronary intervention (PCI) with second-generation drug-eluting stent (DES) for left main coronary artery (LMCA) disease. Using individual patient-level data from the IRIS-MAIN and KOMATE registries, 1,827 patients undergoing PCI with second-generation DES for LMCA disease with valid information on the DAPT duration were included. The primary outcome was major adverse cardiovascular events (MACE, a composite of cardiac death, myocardial infarction, stent thrombosis) and the safety outcome was major bleeding. The DAPT duration was < 6 months (n = 273), 6–12 months (n = 477), 12–24 months (n = 637), and ≥ 24 months (n = 440). The median follow-up duration was 3.9 years (interquartile range, 3.01–5.00 years). The prolonged DAPT duration was associated with lower incidences of MACE. In multi-group propensity score analysis, adjusted hazard ratios (HRs) for MACE were significantly higher for DAPT < 6 months and DAPT 6–12 months than for DAPT 12–24 months (HR, 4.51; 95% confidence interval [CI], 2.96–6.88 and HR 1.92; 95% CI, 1.23–3.00)]. There was no difference in the HRs for major bleeding among the assessed groups. In real world registries data, DAPT duration following PCI for LMCA disease varies depending on the characteristics of the patient. Overall, the prolonged DAPT duration was associated with lower incidence of MACE without increased major bleeding.