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Optimal Duration for Dual Antiplatelet Therapy After Left Main Coronary Artery Stenting
Jungho Choi1,2, In-Soo Kim3, Sungsoo Cho4
1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine.
Insights
Prolonging dual antiplatelet therapy (DAPT) beyond 12 months after drug-eluting stent (DES) implantation in left main coronary artery (LMCA) lesions improves outcomes. Extended DAPT reduces adverse cardiovascular events without increasing bleeding risk.
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.
Background:
Coronary interventions using drug-eluting stents (DESs) of left main coronary artery (LMCA) lesions have shown favorable clinical outcomes. However, duration of dual antiplatelet therapy (DAPT) after LMCA interventions has not yet been investigated.
Methods And Results:
From a multicenter Korean Multicenter Angioplasty Team (KOMATE) registry, 1,004 patients who received DES implantations for LMCA lesions and did not experience major adverse cardiovascular events (including major bleeding) for 1 year after coronary intervention were analyzed. Patients were divided into 2 groups; DAPT ≤12 (n=503) and >12 months (n=501). The primary endpoint was number of net clinical adverse events (NACEs), composite of cardiac deaths, myocardial infarctions, stent thrombosis and major bleeding events. During a 4.5-year follow-up period after LMCA interventions, the DAPT >12 months group showed a lower NACE rate than the DAPT ≤12 months group (adjusted-HR 0.53 [0.29-0.99], P=0.045). For patients who maintained DAPT >12 months, rate of cardiac deaths, myocardial infarctions, and stent thrombosis events were lower than in patients who had DAPT ≤12 months (adjusted-HR 0.35 [0.17-0.73], P=0.005) without increased major bleeding (P=0.402).
Conclusions:
For patients who can continue DAPT without major bleeding events, prolonged DAPT (>12 months) after LMCA stenting demonstrated better long-term efficacy outcomes than DAPT ≤12 months with comparable safety.
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