Key result
Nonextended DAPT linked to ~447% higher cardiac death or MI risk after first-generation DES only.
Why the study?
The difference in clinical outcomes between nonextended and extended dual antiplatelet therapy in AMI patients with different generations of drug-eluting stents remains unclear.
Does nonextended DAPT compared to extended DAPT affect the rate of cardiac death or MI in patients with AMI implanted with first- or second-generation DES?
Cohort (n=790)
Does nonextended DAPT compared to extended DAPT affect the rate of cardiac death or MI in patients with AMI implanted with first- or second-generation DES?
Extended DAPT beyond 12 months may reduce cardiac death or MI in AMI patients with first-generation DES, but does not appear to offer the same benefit for those with second-generation DES.
Answers are grounded in this paper and cite their sources.
May support extended DAPT after first-generation DES in AMI; leaves open optimal duration for second-generation DES.
BACKGROUND: The difference of the clinical outcomes between nonextended (≤12 months) and extended (>12 months) dual antiplatelet therapy (DAPT) remains unclear in patients with acute myocardial infarction (AMI) implanted by different generations of drug-eluting stent (DES). METHODS: We identified 790 consecutive patients with AMI who were free from major adverse cardiac events for 12 months after first-generation (n = 537) or second-generation DES (n = 253) implantation; each DES generation group was further divided into nonextended and extended DAPT. RESULTS: During follow-up (median: 40 months), nonextended DAPT in the first-generation DES group showed a higher rate of cardiac death or MI than was observed in the extended DAPT group (14% vs 2%, P < 0.001). However, in the second-generation DES group, there was no difference in the occurrence of cardiac death and MI between the extended and nonextended groups (4% vs 3%, P = 0.809). Nonextended DAPT was the most significant predictor of cardiac death and MI for first-generation DES implantation [hazard ratio (HR) = 5.47, 95% confidence interval (CI) = 1.53-19.59, P = 0.009] but not for second-generation DES implantation [HR = 3.21, 95% CI = 0.21-50.65, P = 0.401]. CONCLUSION: This study suggested that the clinical outcomes between nonextended and extended DAPT might be different depending on the generation of implanted DESs in patients with AMI.
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Kang et al. (2012) conducted a cohort in Acute Myocardial Infarction (n=790). Nonextended (≤12 months) dual antiplatelet therapy vs. Extended (>12 months) dual antiplatelet therapy was evaluated on Cardiac death or MI (HR 5.47, 95% CI 1.53-19.59, p=0.009). Nonextended DAPT (≤12 months) increased cardiac death or MI risk compared to extended DAPT after first-generation DES implantation (HR 5.47; 95% CI 1.53-19.59), but not second-generation DES.
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