Key result
Prolonged DAPT (≥12 months) after drug-eluting stent implantation for bifurcation lesions was associated with a lower risk of death or MI at 4 years (2.8% vs 12.3%; HR 0.21; 95% CI 0.13-0.35).
Why the study?
Does prolonged dual antiplatelet therapy (≥12 months) reduce all-cause death or myocardial infarction in patients who are event-free 12 months after drug-eluting stent implantation for coronary bifurcation lesions?
Cohort (n=2,082)
Does prolonged dual antiplatelet therapy (≥12 months) reduce all-cause death or myocardial infarction in patients who are event-free 12 months after drug-eluting stent implantation for coronary bifurcation lesions?
Hazard Ratio: 0.21 (95% CI 0.13–0.35)
Absolute Event Rate: 2.8% vs 12.3%
p-value: p=<0.001
Prolonged DAPT (≥12 months) is associated with a significantly lower risk of death or MI at 4 years in patients who remain event-free 12 months after DES implantation for coronary bifurcation lesions.
May support extended DAPT after bifurcation stenting; leaves open need for randomized confirmation before practice change.
Background: Whether prolonged dual antiplatelet therapy (DAPT) improves clinical outcomes after percutaneous coronary intervention for coronary bifurcation lesion is uncertain. Methods and Results: We evaluated 2082 patients who were treated with drug-eluting stent for bifurcation lesions and were event free (no death, myocardial infarction [MI], cerebrovascular accident, stent thrombosis, or any revascularization) at 12 months after the index procedure. Patients were divided into 2 groups: DAPT ≥12-month group (n=1776) and DAPT <12-month group (n=306). Primary outcome was all-cause death or MI. At 4 years after the index procedure, death or MI occurred less frequently in the DAPT ≥12-month group than the DAPT <12-month group (2.8% versus 12.3%; adjusted hazard ratio, 0.21; 95% confidence interval, 0.13–0.35; P <0.001). After propensity score matching, incidence of death or MI was still lower in the DAPT ≥12-month group than the DAPT <12-month group (2.6% versus 12.3%; adjusted hazard ratio, 0.22; 95% confidence interval, 0.12–0.38; P <0.001). In subgroup analysis, the treatment effect of prolonged DAPT was consistent across subgroups regardless of lesion location, stenting technique, or type of used drug-eluting stent. Conclusions: The risk of all-cause death or MI was significantly lower in the ≥12-month DAPT group than the <12-month DAPT group after percutaneous coronary intervention for bifurcation lesion using drug-eluting stent. Our results suggest that prolonged DAPT may improve long-term clinical outcomes after percutaneous coronary intervention for bifurcation lesions. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01642992
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Jang et al. (2018) conducted a cohort in Coronary bifurcation lesions (n=2,082). Prolonged dual antiplatelet therapy (≥12 months) vs. Dual antiplatelet therapy <12 months was evaluated on All-cause death or myocardial infarction (adjusted HR 0.21, 95% CI 0.13-0.35, p=<0.001). Prolonged DAPT (≥12 months) after drug-eluting stent implantation for bifurcation lesions was associated with a lower risk of death or MI at 4 years (2.8% vs 12.3%; HR 0.21; 95% CI 0.13-0.35).
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