Key result
Among patients treated with percutaneous coronary intervention for chronic total occlusion, dual antiplatelet therapy for ≤12 months was associated with similar rates of major adverse cardiac and cerebrovascular events compared to >12 months (HR 0.95).
Why the study?
Does dual antiplatelet therapy for ≤ 12 months compared to > 12 months improve clinical outcomes in patients treated with PCI for coronary chronic total occlusion?
Cohort (n=512)
No
Does dual antiplatelet therapy for ≤ 12 months compared to > 12 months improve clinical outcomes in patients treated with PCI for coronary chronic total occlusion?
Hazard Ratio: 0.95 (95% CI 0.52–1.76)
Absolute Event Rate: 19.4% vs 18.8%
p-value: p=0.88
In patients undergoing successful PCI for chronic total occlusion, extending dual antiplatelet therapy beyond 12 months did not significantly reduce major adverse cardiac and cerebrovascular events or increase major bleeding compared to 12 months or less of therapy.
May support limiting DAPT to 12 months after CTO PCI; leaves open confirmation by randomized trials.
BACKGROUND: The duration of dual antiplatelet therapy (DAPT) after drug-eluting stent implantation in coronary chronic total occlusion (CTO) remains unclear. METHODS: We retrospectively analyzed a total of 512 patients treated with percutaneous coronary intervention (PCI) in the Samsung Medical Center CTO registry. Patients were separated into ≤ 12-month (199, 38.9%) vs. > 12 month (313, 61.1%) based on DAPT duration with aspirin and clopidogrel. The primary outcome was major adverse cardiac and cerebrovascular event (MACCE) during follow-up. RESULTS: Median follow-up duration was 67 (interquartile range: 51-84) months. MACCE occurred in 43 patients (21.6%) in the ≤ 12-month and 55 patients (17.6%) in the > 12-month groups. In the propensity-matched population, the rate of MACCE did not differ significantly between the ≤ 12-month and > 12-month group (19.4% vs. 18.8%; hazard ratio [HR], 0.95; 95% confidential interval [CI], 0.52-1.76, p = 0.88). Moreover, moderate or severe bleeding according to BARC criteria (type 2, 3 or 5) was also similar between the ≤ 12-month and > 12-month group (2.5% vs. 1.9%; HR, 1.00; 95% CI, 0.20-4.96, p = 0.99). CONCLUSION: Among patients treated with PCI for CTO, DAPT with durations of ≤ 12-month showed similar long-term clinical outcomes compared to > 12-month DAPT.
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Lee et al. (2017) conducted a cohort in Coronary chronic total occlusion (CTO) (n=512). Dual antiplatelet therapy (DAPT) ≤ 12 months vs. Dual antiplatelet therapy (DAPT) > 12 months was evaluated on Major adverse cardiac and cerebrovascular event (MACCE) (HR 0.95, 95% CI 0.52-1.76, p=0.88). Among patients treated with percutaneous coronary intervention for chronic total occlusion, dual antiplatelet therapy for ≤12 months was associated with similar rates of major adverse cardiac and cerebrovascular events compared to >12 months (HR 0.95).
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