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Dual antiplatelet therapy for more than 12 months after percutaneous coronary intervention: insights from the Guthrie
K J Harjai1, C Shenoy, P Orshaw
1Guthrie Health System, Sayre, Pennsylvania 18840, USA. harjai_kishore@guthrie.org
Insights
Extending dual antiplatelet therapy (DAP) beyond 12 months after percutaneous coronary intervention (PCI) does not reduce long-term death or myocardial infarction (MI) risk. This finding applies to patients who have already survived event-free for at least a year post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAP) is crucial after percutaneous coronary intervention (PCI) to prevent stent thrombosis and ischemic events.
- Optimal duration of DAP remains debated, particularly in patients achieving successful PCI and surviving event-free for at least 12 months.
- Long-term outcomes and the incremental benefit of extended DAP are critical considerations for clinical practice.
Purpose of the Study:
- To evaluate the impact of continuing dual antiplatelet therapy (DAP) for more than 12 months on long-term death and myocardial infarction (MI) rates.
- To assess whether extended DAP confers additional protection in patients who have already undergone successful native coronary PCI and remained event-free for one year.
Main Methods:
- A prospective, single-center observational study included 1859 consecutive patients with successful native coronary artery PCI.
- Patients were analyzed based on the duration of DAP: >12 months versus <=12 months.
- Outcomes (death or non-fatal MI) were assessed using survival analysis and propensity-adjusted Cox regression, with subgroup analyses for stent types and high-risk patient groups.
Main Results:
- Patients receiving DAP >12 months had a median duration of 27 months, compared to 4.1 months for those receiving DAP <=12 months.
- At a median follow-up of 3.4 years, the incidence of death or MI was similar between the two groups (9.4% vs 10.3%, p=0.83).
- Multivariable analysis showed no significant association between DAP >12 months and a reduced risk of death or MI (adjusted HR = 1.01; 95% CI 0.74 to 1.37, p=0.95).
Conclusions:
- Continuation of dual antiplatelet therapy beyond 12 months does not provide significant long-term protection against death or myocardial infarction in patients with successful PCI who are event-free at 12 months.
- These findings suggest that extended DAP may not be necessary for all patients in this specific cohort, warranting individualized treatment decisions.
Objective:
To assess the impact of dual antiplatelet (DAP) therapy of >12 months on long-term death and myocardial infarction (MI) after percutaneous coronary intervention (PCI).
Design, Setting And Patients:
Prospective, single-centre, observational study of 1859 consecutive patients who underwent successful PCI of a native coronary artery and survived event-free for at least 12 months.
Main Outcome Measures:
Combined end point of death or non-fatal MI determined by survival analysis and propensity-adjusted multivariable Cox regression. Similar analyses were performed in the two stent subsets: bare metal stents (n = 835), drug-eluting stents (n = 1024); and three high-risk subsets: diabetic patients (n = 486), patients presenting with MI (n = 713), and those with ACC/AHA type C lesions (n = 717).
Results:
Baseline characteristics were as follows: mean (SD) age 64 (12) years, male 69%, diabetic 26%, presentation with MI 38%, mean (SD) ejection fraction 49 (12)%, mean (SD) vessel diameter 3.1 (0.5) mm. Duration of DAP was 27 (11) months in "DAP >12 months" and 4.1 (4.1) months in "DAP < or =12 months" (p<0.001). At a median follow-up of 3.4 years after PCI, "DAP >12 months" vs "DAP < or =12 months" had similar incidence of death or MI (9.4% vs 10.3%, log-rank p = 0.83). After multivariable adjustment, DAP therapy >12 months was not associated with lower incidence of death or MI than DAP therapy < or =12 months (adjusted HR = 1.01; 95% CI 0.74 to 1.37, p = 0.95). Analysis of each of the five predefined subsets showed similar results.
Conclusions:
In patients who undergo successful native coronary PCI and survive event-free for at least 12 months, continuation of dual antiplatelet therapy beyond 12 months does not confer long-term protection from death or MI.
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