Correlation study about duration of dual antiplatelet therapy and prognosis in patients undergoing percutaneous coronary intervention

Abstract

Objective To investigate the relationship between the compliance of dual anti-platelet therapy (DAPT) and its treatment time and clinical prognosis in patients with coronary heart disease after performed percutaneous coronary intervention (PCI). Methods The 419 patients with coronary heart disease who successfully undergone PCI (drug-eluting stent implantation, DES) in the Second Hospital of Shanxi Medical University from January 2011 to January 2012 were enrolled in our study. The follow-up performed in all patients, including clinical characteristic, relevant risk factors, medication compliance and treatment time of DAPT, and the recurrence of major adverse cardiovascular events (MACE) after discharged. To analysis the effect of medication compliance and treatment time of DAPT to clinical prognosis. Results A total of 412 patients were successfully followed up during 3-24(22.6±4.2) months, 1.7% patients unfinished follow-up. The 392 patients (95.1%) maintained adherence to the DAPT medication during hospitalization of PCI; To 6 months, 1 year, 2 years after discharged, there were still 374 cases (90.8%), 338 cases (82.0%), 164 cases (39.8%) insisted on the application of DAPT respectively, only 23 cases (5.6%), 43 cases (10.5%), 168 cases (40.8%) used one kind of anti-platelet drugs, 15 cases (3.6%), 31 cases (7.5%), 80 cases (19.4%) fully stopped antiplatelet therapy. Compared to non-DAPT patients, the recurrence of MACE was reduced significantly in patients with DAPT in 6 months, 1 year, 2 years after discharged, respectively (6 months: 42.1% vs. 9.4%, P<0.001; 1 year: 33.8% vs. 7.7%, P<0.001; 2 years: 15.3% vs. 7.9%, P=0.026). Both the recurrence of MACE in patients adherence to DAPT with 1 year and 2 years were significantly lower than that with 6 months (25.0% vs. 7.5%, P=0.001; 25.0% vs. 7.9%, P=0.002); There was no significant difference in recurrence of MACE between 1 year and 2 years DAPT medication (7.5% vs. 7.9%, P=0.894). Conclusions The compliance of DAPT in patients after PCI is generally well. The incidence of MACE obviously increases in patients who stop DAPT medication completely or has only one kind of anti-platelet drugs, and two years DAPT medication doesn't significantly reduce the incidence of MACE compared with one year DAPT medication. Key words: Atherosclerosis; Angioplasty, transluminal, percutaneous coronary; Platelet aggregation inhibitors; Medication adherence; Prognosis