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Clinical outcomes of dual antiplatelet therapy after implantation of drug-eluting stents in patients with different cardiovascular risk factors

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Abstract

Background

The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been established yet. The objectives of this study were to evaluate the optimal duration of DAPT after the DES implantation.

Methods

From three randomized controlled trials investigating DAPT duration after coronary stent implantation, we evaluated the clinical outcomes of short-term (6 months or less) DAPT compared with prolonged DAPT (12 months or more) in 1661 DES-treated pairs matched by propensity scores. At follow-up of 1 year, net adverse clinical event (NACE) was defined as cardiac death, myocardial infarction, target vessel revascularization, definite/probable stent thrombosis, or thrombolysis in myocardial infarction major bleeding.

Results

Short-term DAPT as compared with prolonged DAPT was not associated with 1-year NACEs after DES implantation [hazard ratio (HR) 1.068, 95 % confidence interval (CI) 0.787–1.450, p = 0.671]. Predictors for NACEs were old age (>75 years), hypertension, diabetes mellitus, renal dysfunction (serum creatinine ≥2.0 mg/dL), and multi-vessel disease. The DAPT strategy differentially contributed to the occurrence of NACEs according to the risk burden (p for interaction <0.001). In patients with low risk for NACEs, bleeding events were less in short-term DAPT than in prolonged DAPT (HR 0.332, 95 % CI 0.130–0.849, p = 0.021) (p for interaction = 0.098). Meanwhile, short-term DAPT was associated with more ischemic events that included cardiac death, myocardial infarction, target vessel revascularization, or definite/probable stent thrombosis (HR 2.164, 95 % CI 1.340–3.494, p = 0.002) (p for interaction <0.001) in patients with high risk for NACEs.

Conclusion

One-year clinical outcomes of DAPT after DES implantation depended on the burden of cardiovascular risk.

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Acknowledgments

This study was supported by a grant from the Korea Healthcare Technology Research and Development Project, Ministry for Health and Welfare, Republic of Korea (Nos. A085136 and HI15C1277), the Mid-career Researcher Program through NRF Grant funded by the MEST, Republic of Korea (No. 2015R1A2A2A01002731), and the Cardiovascular Research Center, Seoul, Korea.

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Authors and Affiliations

  1. Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea

    Seung-Yul Lee

  2. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Yonsei-ro 50-1, Seodaemun-Gu, Seoul, Korea

    Myeong-Ki Hong, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi & Yangsoo Jang

  3. Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea

    Myeong-Ki Hong, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi & Yangsoo Jang

  4. Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea

    Myeong-Ki Hong & Yangsoo Jang

  5. Cardiovascular Center, Seoul National University Hospital, Seoul, Korea

    Hyo-Soo Kim

  6. Department of Cardiology, Bern University Hospital, Bern, Switzerland

    Marco Valgimigli

  7. Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Bologna, Italy

    Tullio Palmerini

  8. Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA

    Gregg W. Stone

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  1. Seung-Yul Lee
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  11. Tullio Palmerini
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Correspondence to Myeong-Ki Hong.

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Lee, SY., Hong, MK., Shin, DH. et al. Clinical outcomes of dual antiplatelet therapy after implantation of drug-eluting stents in patients with different cardiovascular risk factors. Clin Res Cardiol 106, 165–173 (2017). https://doi.org/10.1007/s00392-016-1035-4

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