Key result
Prolonged DAPT after LMCA stenting linked to ~47% lower NACE versus shorter DAPT.
Why the study?
While DES for LMCA lesions show favorable clinical outcomes, the optimal duration of DAPT after LMCA interventions has not yet been investigated.
Does prolonged dual antiplatelet therapy (>12 months) reduce net clinical adverse events in patients who received drug-eluting stents for left main coronary artery lesions and remained event-free for 1 year?
Cohort (n=1,004)
Yes
Does prolonged dual antiplatelet therapy (>12 months) reduce net clinical adverse events in patients who received drug-eluting stents for left main coronary artery lesions and remained event-free for 1 year?
Answers are grounded in this paper and cite their sources.
Prolonged dual antiplatelet therapy (>12 months) after left main coronary artery stenting in patients who are event-free at 1 year is associated with reduced ischemic events and net adverse clinical events without significantly increasing major bleeding.
BACKGROUND: Coronary interventions using drug-eluting stents (DESs) of left main coronary artery (LMCA) lesions have shown favorable clinical outcomes. However, duration of dual antiplatelet therapy (DAPT) after LMCA interventions has not yet been investigated. METHODS AND RESULTS: From a multicenter Korean Multicenter Angioplasty Team (KOMATE) registry, 1,004 patients who received DES implantations for LMCA lesions and did not experience major adverse cardiovascular events (including major bleeding) for 1 year after coronary intervention were analyzed. Patients were divided into 2 groups; DAPT ≤12 (n=503) and >12 months (n=501). The primary endpoint was number of net clinical adverse events (NACEs), composite of cardiac deaths, myocardial infarctions, stent thrombosis and major bleeding events. During a 4.5-year follow-up period after LMCA interventions, the DAPT >12 months group showed a lower NACE rate than the DAPT ≤12 months group (adjusted-HR 0.53 [0.29-0.99], P=0.045). For patients who maintained DAPT >12 months, rate of cardiac deaths, myocardial infarctions, and stent thrombosis events were lower than in patients who had DAPT ≤12 months (adjusted-HR 0.35 [0.17-0.73], P=0.005) without increased major bleeding (P=0.402). CONCLUSIONS: For patients who can continue DAPT without major bleeding events, prolonged DAPT (>12 months) after LMCA stenting demonstrated better long-term efficacy outcomes than DAPT ≤12 months with comparable safety.
No takes yet. Share an insight, caveat, or question.
Choi et al. (2020) conducted a cohort in Left main coronary artery disease (n=1,004). Prolonged dual antiplatelet therapy (DAPT >12 months) vs. DAPT ≤12 months was evaluated on Net clinical adverse events (NACEs), a composite of cardiac deaths, myocardial infarctions, stent thrombosis, and major bleeding events (HR 0.53, 95% CI 0.29-0.99, p=0.045). Prolonged dual antiplatelet therapy (>12 months) after left main coronary artery stenting reduced net clinical adverse events by 47% compared to DAPT ≤12 months (HR 0.53).
Synapse has enriched 10 related papers. Consider them for comparative context: