Comparative Evaluation of Prolonged Dual Antiplatelet Therapy versus Conventional Regimens on Prognosis in Patients...

High residual inflammatory risk (hs-CRP≥2mg/L) predicts worse prognosis and increased ischemic risk following percutaneous coronary intervention (PCI). The optimal duration of dual antiplatelet therapy (DAPT) and its risk-benefit profile in post-PCI patients with high residual inflammatory risk remain unclear.

Patients undergoing PCI with high residual inflammatory risk at Fuwai Hospital were consecutively enrolled. Patients were stratified into two groups based on DAPT duration: prolonged (>12 months) and conventional (≤12 months) groups. The primary outcome was a composite endpoint of all-cause death, myocardial infarction, definite or probable stent thrombosis, or stroke at 3 years. The key safety outcome was the 3-year rate of Bleeding Academic Research Consortium 2, 3, or 5 bleeding.

Among post-PCI patients with high residual inflammatory risk, 2440 individuals (69.5%) continued DAPT beyond 12 months. After three years of follow-up, prolonged DAPT was associated with a significantly lower risk of the primary outcome (1.5% vs. 4.2%; adjusted hazard ratio [HR]: 0.347, 95% CI: 0.224-0.539). Similar benefits were observed for net adverse clinical events (1.4% vs. 4.1%; adjusted HR: 0.338, 95% CI: 0.216-0.53) and for the composite endpoint of all-cause death or myocardial infarction (0.6% vs. 3.1%; adjusted HR: 0.182, 95% CI: 0.097-0.341). Notably, the key safety endpoint did not differ significantly between the two DAPT durations during follow-up (1.0% vs. 1.2%; adjusted HR: 0.793, 95% CI: 0.401-1.57).

In patients who underwent PCI with high residual inflammatory risk, prolonged DAPT improved clinical outcomes by mitigating ischemic risk without increasing clinically significant bleeding.