Optimal Strategy for Antiplatelet Therapy After Coronary Drug-Eluting Stent Implantation in High-Risk “TWILIGHT-like” Patients With Diabetes Mellitus

Figures

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  Figure 1. Study cohort. *Subjects may have >1 event. BARC, Bleeding Academic Research Consortium; CAD, coronary artery disease; DES, drug-eluting stent; DAPT, dual antiplatelet therapy; LAD, left anterior descending; MI, myocardial infarction; PCI, percutaneous coronary intervention.

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  Figure 2. Cumulative incidence of the study outcomes stratified by DAPT duration. Time-to-event curves for (A) major adverse cardiovascular or cerebrovascular events (MACCE) (all-cause mortality, myocardial infarction, or stroke), (B) all-cause mortality, (C) cardiovascular mortality, (D) myocardial infarction, (E) stent thrombosis (definite or probable), (F) stroke, (G) clinically relevant bleeding, and (H) net clinical benefit, according to the duration of DAPT (≤ 1-year vs. >1-year DAPT). MACCE indicates major adverse cardiac and cerebrovascular events.

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  Figure 3. Cumulative incidence of endpoint events stratified by the number of TWILIGHT inclusion criteria fulfilled and duration of DAPT in patients with diabetes mellitus (DM). Outcomes were analyzed comparing DAPT >1-year vs. DAPT ≤ 1-year among subgroups of subjects 1–3 (n = 980), 4–5 (n = 1,827), or 6–9 (n = 618) TWILIGHT inclusion criteria to assess whether anti-ischemic effects of DAPT duration differed depending on the number of TWILIGHT inclusion features fulfilled in patients with DM. The treatment effects of extended DAPT over 1 year were consistent for the outcomes of MACCE, clinically relevant bleeding, and net clinical benefit outcome independent of the number of high-risk enrichment features fulfilled.

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  Figure 4. Comparative unadjusted hazard ratios of MACCE (A), clinically relevant bleeding (B), and net clinical benefit outcome (C) according to duration of DAPT stratified by number of TWILIGHT inclusion criteria fulfilled in patients with DM. The effect of DAPT >1-year vs. DAPT ≤ 1-year for MACCE, clinically relevant bleeding, and net clinical benefit outcome was consistent across patients with 1–3 (n = 980), 4–5 (n = 1,827), or 6–9 (n = 618) high-risk clinical and angiographic fulfilled in patients with DM. CI, confidence interval; HR, hazard ratio; MACCE, major adverse cardiovascular or cerebrovascular events.

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  Figure 5. Subgroup analysis of the primary efficacy endpoint of MACCE according to duration of DAPT (DAPT >1-year vs. DAPT ≤ 1-year). Data are shown as the number of MACCE per total number of patients in that subgroup and the event rate. BMI was calculated as weight in kilograms divided by height in meters squared. The P-value for interaction represents the likelihood of interaction between the variable and the treatment. ACS, acute coronary syndrome; BMI, body mass index; CAD, coronary artery disease; CKD, chronic kidney disease; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction.