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Determinants and Clinical Outcomes of Extended Dual Antiplatelet Therapy over 3 Years after Drug-Eluting Stent Implantation: A Retrospective Analysis

Yonsei Medical Journal 2020년 61권 7호 p.597 ~ 605
이오현 ( Lee Oh-Hyun ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology

김병극 ( Kim Byeong-Keuk ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
홍성진 ( Hong Sung-Jin ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
금성환 ( Kim Seung-Hwan ) - Inje University College of Medicine Haeundae Paik Hospital Department of Internal Medicine
안철민 ( Ahn Chul-Min ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
신동호 ( Shin Dong-Ho ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
김정순 ( Kim Jung-Sun ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
강태수 ( Kang Tae-Soo ) - Dankook University College of Medicine Dankook University Hospital Department of Internal Medicine
고영국 ( Ko Young-Guk ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
최동훈 ( Choi Dong-Hoon ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
홍명기 ( Hong Myeong-Ki ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
장양수 ( Jang Yang-Soo ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology

Abstract


Purpose: Although current guidelines recommend the administration of dual antiplatelet therapy (DAPT) for up to 12 months after the implantation of a drug-eluting stent (DES), extended DAPT is frequently used in real-world practice.

Materials and Methods: From the Korean Multicenter Angioplasty Team registry, we identified a total of 1414 patients who used DAPT for >3 years after DES implantation (extended-DAPT group) and conducted a landmark analysis at 36 months after the index procedure. We evaluated the determinants for and long-term outcomes of extended DAPT and compared the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as the composite of all-cause death, myocardial infarction, stent thrombosis, and stroke, between the extended-DAPT group and the guideline-DAPT group [DAPT <1 year after DES implantation (n=1273)].

Results: Multivariate analysis indicated the occurrence of acute coronary syndrome as the most significant clinical determinant of the use of extended DAPT. Bifurcation, stent diameter ≤3.0 mm, total stented length ≥28 mm, and use of first-generation DESs were also significant angiographic and procedural determinants. MACCE rates were similar between the extended-DAPT group and the guideline-DAPT group in crude analysis [hazard ratio (HR), 1.08; 95% confidence interval (CI), 0.69?1.68; p=0.739] and after propensity matching (HR, 1.22; 95% CI, 0.72?2.07; p=0.453). Major bleeding rates were comparable between the two groups.

Conclusion: In patients undergoing percutaneous coronary intervention, indefinite use of DAPT does not show superior outcomes to those of guideline-DAPT. Major bleeding rates are also similar.

키워드

Antiplatelet therapy; drug-eluting stent; percutaneous coronary intervention
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