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Impact of Dual Antiplatelet Therapy Duration on Long-Term Outcomes Following Chronic Total Occlusion Percutaneous
Yao Jiang1, Han Zhang1, Chujie Zhang1
1Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Prolonged dual antiplatelet therapy (DAPT) after percutaneous coronary intervention for chronic total occlusion reduces cardiac events but increases minor bleeding risk. Optimal DAPT duration balances these outcomes for high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) is not well-defined.
- CTO PCI patients represent a high-risk cohort with complex anatomy and procedures.
Purpose of the Study:
- To determine the optimal DAPT duration in patients undergoing CTO PCI.
- To evaluate the trade-off between ischemic events and bleeding risk.
Main Methods:
- A cohort of 2659 CTO PCI patients were enrolled between 2010-2013.
- Patients were categorized into long-term (>12 months) or short-term (≤12 months) DAPT groups based on duration after 12 months without adverse events.
- Primary endpoint: composite of cardiac death and spontaneous myocardial infarction at 5 years. Safety endpoint: Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding at 5 years.
Main Results:
- 1923 patients were analyzed; 1104 (57.4%) received long-term DAPT.
- Long-term DAPT was associated with a significantly lower rate of the primary outcome (3.6% vs 6.3%; aHR 0.58; P = .01), driven by reduced cardiac death (0.1% vs 4.0%; P < .001).
- Long-term DAPT increased the risk of BARC 2-5 bleeding (3.8% vs 1.5%; aHR 2.61; P < .01), while BARC 3+ bleeding risk was comparable.
Conclusions:
- In CTO PCI patients, prolonged DAPT beyond 12 months reduces ischemic events, specifically cardiac death and myocardial infarction.
- However, extended DAPT is linked to an increased risk of minor bleeding (BARC 2-5).
- The findings suggest a need for individualized DAPT duration strategies in this complex patient population.
Background:
Optimal dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention for coronary chronic total occlusion remains unclear. Thus, we aim to determine the optimal DAPT duration in this high-risk cohort with complex anatomy and procedures.
Methods:
Between January 2010 and December 2013, 2659 consecutive chronic total occlusion patients undergoing percutaneous coronary intervention at Fuwai Hospital were enrolled, and those without adverse events within 12 months were categorized into long-term (>12 months) or short-term (≤12 months) groups according to DAPT duration. The primary endpoint was a composite of cardiac deaths and spontaneous myocardial infarction at 5 years. The safety endpoint was the rate of Bleeding Academic Research Consortium (BARC) 2, 3, or 5 type bleeding at 5 years.
Results:
Overall, 1923 patients were included in the final analysis, of which 1104 (57.4 %) continued DAPT beyond 12 months. Compared with short-term DAPT, long-term DAPT was associated with a lower rate of primary outcome (3.6 % vs 6.3 %; adjusted hazard ratio [aHR] 0.58; 95 % confidence interval [CI], 0.38-0.89, P = .01), primarily driven by fewer cardiac deaths (0.1 % vs 4.0 %, aHR 0.02; 95 % CI, 0.00-0.17; P < .001) and a higher risk of BARC 2-5 bleeding (3.8 % vs 1.5 %; aHR 2.61; 95 % CI, 1.37 to 4.97, P < .01), whereas the risk of BARC 3 or greater was comparable between groups.
Conclusion:
In patients undergoing chronic total occlusion percutaneous coronary intervention, prolonged DAPT was associated with a reduced risk of cardiac death and myocardial infarction, but with an increased risk of minor bleeding.
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