Key result
Prolonged DAPT linked to ~46% lower MACCE vs standard therapy in complex PCI for diabetics.
Why the study?
The optimal duration of dual antiplatelet therapy after PCI remains controversial, especially in diabetic patients undergoing complex coronary interventions who are at high ischemic risk.
Does prolonging DAPT duration improve long-term prognosis in diabetic patients undergoing complex PCI with DES?
Cohort (n=2,403)
No
Does prolonging DAPT duration improve long-term prognosis in diabetic patients undergoing complex PCI with DES?
Hazard Ratio: 0.544 (95% CI 0.373–0.795)
Absolute Event Rate: 4.6% vs 8.1%
p-value: p=0.008
Prolonging DAPT beyond 13 months in diabetic patients undergoing complex PCI is associated with reduced all-cause and cardiac mortality without a significant increase in major bleeding.
Should not yet alter DAPT duration in diabetic complex PCI; hypothesis-generating for mortality benefit and needs RCT confirmation.
Background The optimal dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention (PCI) remains controversial, especially for patients at high risk of ischemic events. Diabetes mellitus (DM) and complex coronary interventions have been considered as high risk factors for ischemic events. We aim to investigate if prolonging DAPT duration in diabetic patients after drug-eluting stent (DES) implantation can reduce long-term adverse events.Methods This study is an observational cohort study carried out in the largest cardiovascular center in China. 10,724 patients who underwent PCI from January, 2013 to December, 2013 were consecutively enrolled. The inclusion criteria included: documented history of DM; underwent DES implantation; free of adverse events within 1 year after operation; and had at least one high thrombotic risk technical aspects. These patients were divided into three groups according to DAPT duration: Standard group (11 ≤ DAPT ≤ 13 months) and prolonged group (13 < DAPT ≤ 24 months; DAPT > 24 months). Baseline characteristics and 5-year clinical outcomes were collected and analyzed. Results A total of 2,403 diabetic patients with complex PCI were included in the current analysis (Standard DAPT n=689; Prolonged DAPT n=1714). Baseline and angiographic characteristics, and complexity of PCI were comparable among patients with different DAPT durations. Patients in 13 24 months was related with lower risk of all-cause death (HR: 0.681, 95%CI: 0.493-0.942) and cardiac death (HR: 0.620, 95%CI: 0.403-0.952). Prolonging DAPT duration did not increase the risk of major bleeding (13 24 months: HR: 0.967, 95%CI: 0.682-1.371).Conclusions For diabetic patients undergoing complex PCI, prolonging DAPT duration might improve long-term prognosis by reducing the risk of adverse ischemia events and without increasing the risk of bleeding.
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Jingjing et al. (2022) conducted a cohort in Diabetes Mellitus and Complex Coronary Artery Disease (n=2,403). Prolonged dual antiplatelet therapy (13-24 months) vs. Standard dual antiplatelet therapy (11-13 months) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, MI and stroke at 5-year follow up (HR 0.544, 95% CI 0.373-0.795, p=0.008). Prolonging dual antiplatelet therapy to 13-24 months reduced MACCE (HR 0.544) compared to standard 11-13 months therapy in diabetic patients undergoing complex PCI.
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