Key result
Continuation of DAPT beyond 1 year after PCI in high-risk patients was associated with a lower risk of MACCE compared to DAPT ≤1 year (1.5% vs. 3.8%; HR 0.37; 95% CI 0.27-0.50; P<.001).
Why the study?
The benefits and harms of DAPT continuation with aspirin and clopidogrel beyond 1 year after PCI with DES implantation in patients with high ischemic or bleeding risk remain unclear.
Does extended dual antiplatelet therapy beyond 1 year reduce major adverse cardiac and cerebrovascular events in high-risk patients event-free at 1 year after PCI?
Cohort (n=7,521)
Does extended dual antiplatelet therapy beyond 1 year reduce major adverse cardiac and cerebrovascular events in high-risk patients event-free at 1 year after PCI?
Hazard Ratio: 0.37 (95% CI 0.27–0.5)
Absolute Event Rate: 1.5% vs 3.8%
p-value: p=< .001
Extended dual antiplatelet therapy beyond 1 year in high-risk patients who are event-free at 1 year post-PCI significantly reduces MACCE and all-cause mortality without increasing clinically relevant bleeding.
Extended DAPT was associated with lower MACCE without excess bleeding in high-risk event-free patients; leaves open need for RCTs before practice change.
The benefits and harms of dual antiplatelet therapy (DAPT) continuation with aspirin and clopidogrel beyond 1 year after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation for high ischemic or bleeding risk patients remain unclear. All consecutive patients undergoing PCI were prospectively included in the Fuwai PCI Registry from January 2013 to December 2013. We evaluated 7521 patients who were at high risk for thrombotic or hemorrhagic complications and were events free at 1 year after the index procedure. “TWILIGHT-like” patients with high risk of bleeding or ischemic events were defined by clinical and angiographic criteria. The primary ischemic outcome was major adverse cardiac and cerebrovascular events [MACCE] (a composite of all-cause death, myocardial infarction, or stroke). Median follow-up duration was 2.4 years. The risk of MACCE was significantly lower in DAPT>1-year group (n = 5252) than DAPT≤1-year group (n = 2269) (1.5% vs. 3.8%; hazard ratio [HR]: 0.37; 95% confidence interval [CI]: 0.27–0.50; P < .001). This difference was largely driven by a lower risk of all-cause death. In contrast, the risk of Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding was statistically similar between the two groups (1.0% vs. 1.1%; HR: 0.80; 95% CI: 0.50–1.28; P = .346). Results were consistent after multivariable regression and propensity-score matching. Prolonged DAPT beyond 1 year after DES implantation resulted in a significantly lower rate of atherothrombotic events, including a mortality benefit, with no higher risk of clinically relevant bleeding in “TWILIGHT-like” patients who were at high-risk for ischemic or bleeding events.
No takes yet. Share an insight, caveat, or question.
Wang et al. (2020) conducted a cohort in High risk of ischemic or bleeding events after PCI with DES (n=7,521). Dual antiplatelet therapy (DAPT) continuation beyond 1 year vs. DAPT ≤1 year was evaluated on Major adverse cardiac and cerebrovascular events [MACCE] (a composite of all-cause death, myocardial infarction, or stroke) (HR 0.37, 95% CI 0.27-0.50, p=< .001). Continuation of DAPT beyond 1 year after PCI in high-risk patients was associated with a lower risk of MACCE compared to DAPT ≤1 year (1.5% vs. 3.8%; HR 0.37; 95% CI 0.27-0.50; P<.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: