Optimal Duration for Dual Antiplatelet Therapy After Left Main Coronary Artery Stenting

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Drug-eluting stents (DESs) are effective for left main coronary artery (LMCA) lesions.
• Optimal duration of dual antiplatelet therapy (DAPT) post-LMCA intervention remains unclear.

Purpose of the Study:

• To investigate the impact of DAPT duration on clinical outcomes after LMCA stenting.
• To compare safety and efficacy of prolonged DAPT versus standard duration.

Main Methods:

• Analysis of 1,004 patients from the Korean Multicenter Angioplasty Team (KOMATE) registry.
• Patients received DES for LMCA lesions and were stratified by DAPT duration: ≤12 months (n=503) vs. >12 months (n=501).
• Primary endpoint: net clinical adverse events (NACEs) over 4.5-year follow-up.

Main Results:

• The DAPT >12 months group had significantly lower NACE rates (adjusted-HR 0.53; P=0.045).
• Prolonged DAPT was associated with reduced cardiac death, myocardial infarction, and stent thrombosis (adjusted-HR 0.35; P=0.005).
• No significant increase in major bleeding events was observed in the prolonged DAPT group (P=0.402).

Conclusions:

• Extended DAPT (>12 months) improves long-term efficacy after LMCA stenting.
• Prolonged DAPT is safe, with comparable bleeding risk to shorter durations.
• This supports longer DAPT in select patients post-LMCA intervention.