Key result
Target vessel revascularization linked to ~150% higher odds of prolonged DAPT after DES implantation.
Why the study?
Less is known about the actual duration of dual antiplatelet therapy after drug-eluting stent treatment in China.
What is the actual duration of dual antiplatelet therapy (DAPT) and its associated factors after drug-eluting stent (DES) implantation in China?
Observational (n=9,919)
No
What is the actual duration of dual antiplatelet therapy (DAPT) and its associated factors after drug-eluting stent (DES) implantation in China?
Odds Ratio: 2.5 (95% CI 2.04–3.06)
p-value: p=<0.001
In a large Chinese center, 1-year DAPT adherence after DES was high (97.3%), but prolongation beyond 1 year was driven by procedural factors rather than individualized bleeding or ischemic risks.
High 1-year DAPT adherence after DES in China was unadjusted for bleeding or ischemic risk; leaves optimal individualized duration open for prospective trials.
OBJECTIVE: To investigate the actual dual antiplatelet therapy (DAPT) duration after drug-eluting stent (DES) treatment in China. BACKGROUND: Currently, less is known about actual DAPT duration after drug-eluting stent (DES) treatment in China. Here, we performed a study in the largest cardiovascular center in China to investigate DAPT duration and identify associated factors after DES implantation. METHODS: A total of 9,919 consecutive patients with DES implantation from January 2013 to December 2013 were enrolled. DAPT cessation was observed, and factors associated with different DAPT durations were analyzed. RESULTS: The median follow-up time was 882 days. The proportion of patients with DAPT coverage at 1-year of follow-up was 97.3%, and it decreased to 30.1% for 2 years. The distribution of DAPT duration was not significantly different among patients with acute myocardial infarction (AMI) versus non-AMI (P = 0.41) and with new-generation DES versus first-generation DES (P = 0.54). The multivariable analysis indicated some independent predictors prolonging DAPT duration, including target vessel revascularization (OR 2.50, 95% CI 2.04-3.06, P < 0.001), stent numbers (OR 1.10, 95% CI 1.05-1.15, P < 0.001), and previous coronary artery bypass grafting (OR 0.76, 95% CI 0.61-0.96, P = 0.02). Other clinical factors, such as the increased risk of bleeding and high ischemic risk, were not associated with DAPT duration. CONCLUSIONS: The 1-year DAPT after DES was applied to 97.3% of Chinese patients in the studied clinical center. However, the DAPT duration after 1 year was not adjusted according to the patients' bleeding situation and ischemic risks.
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Xu et al. (2018) conducted an observational in Drug-eluting stent (DES) implantation (n=9,919). Target vessel revascularization vs. No target vessel revascularization was evaluated on Prolonging DAPT duration (OR 2.50, 95% CI 2.04-3.06, p=<0.001). Target vessel revascularization independently predicted prolonged DAPT duration after DES implantation (OR 2.50; 95% CI 2.04-3.06), while 97.3% of patients maintained DAPT at 1 year.
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