Association Between Duration of Dual Antiplatelet Therapy and Angiographic Multivessel Disease on Outcomes in Patients Treated With Newer-Generation Drug-Eluting Stents

作者：Lee Seung Yul; Hong Myeong Ki^*; Shin Dong Ho; Kim Jung Sun; Kim Byeong Keuk; Ko Young Guk; Choi Donghoon; Jang Yangsoo; Kim Hyo Soo; Valgimigli Marco; Colombo Antonio; Gilard Martine; Palmerini Tullio; Stone Gregg W

来源：Circulation: Cardiovascular Interventions , 2016, 9(11): e004256.

DOI：10.1161/CIRCINTERVENTIONS.116.004256

• antiplatelet drugs
• coronary artery disease
• drug-eluting stent

Background-There is general agreement that the optimal duration of dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents should be individualized. We hypothesized that the extent of coronary artery disease may affect the clinical outcomes of DAPT.
Methods and Results-We pooled patient-level data from 5 large, randomized trials comparing short-term DAPT with prolonged therapy. From the data, we identified 5476 patients who received newer-generation drug-eluting stents. Net adverse clinical event (NACE) was defined as a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding. At 1 year, NACE had occurred in 171 patients (3.1%). Independent predictors of NACE were older age (>65 years), sex, presence of diabetes mellitus, left ventricular dysejection fraction <40%), and angiographic multivessel disease. Multivessel disease and DAPT duration were significantly associated with NACE (P for interaction=0.002); the association was driven by the greater occurrence of myocardial infarction in patients with multivessel disease. In patients with multivessel disease, 6-month DAPT (versus 12-month DAPT) was associated with a higher incidence of myocardial infarction (adjusted hazard ratio=2.748; 95% confidence interval=1.375-5.491; P=0.004), compared with patients with single-vessel disease (P for interaction=0.001).
Conclusions-In patients treated with newer-generation drug-eluting stents, a significant interaction between DAPT strategy and multivessel disease was found regarding the occurrence of NACE at 1 year. Among adverse events, myocardial infarction was more frequent in 6-month DAPT than in 12-month DAPT in patients with multivessel disease.

• 出版日期2016-11