Abstract
We investigated the real dual antiplatelet therapy (DAPT) duration after the drug-eluting stent (DES) treatment in China. 9,919 consecutive patients with DES implantation were enrolled. The follow-up DAPT cessation and associated factors with different DAPT durations were analyzed. The proportion of patients with DAPT coverage at 1-year follow-up was 97.3%, and decreased to 30.1% for 2-years. The distribution of DAPT duration (<1 year, =1 year and >1 year) was not significantly different among patients presented with AMI versus non-AMI (p=0.41), and new-generation DES versus first-generation DES (p=0.54). The multivariable analysis indicated some independent predictors of prolonging DAPT duration, including TVR (OR 2.50, 95% CI 2.04-3.06, p<0.001), stent numbers (OR 1.10, 95% CI 1.05-1.15, p<0.001), and previous coronary artery bypass grafting (OR 0.76, 95% CI 0.61-0.96, p=0.02). Other clinical factors such as the increased risks of bleeding and high ischemic risks were not associated with DAPT duration. 1-year DAPT after DES was applied to 97.3% in China. However, the DAPT duration after 1 year was not adjusted according to the patients’ bleeding situation and ischemic risks.
Highlights
Dual antiplatelet therapy (DAPT), i.e., aspirin in combination with a P2Y12 antagonist, is an essential component of the treatment of patients undergoing percutaneous coronary intervention (PCI) especially with the drug-eluting stent (DES) [1]
The data coming from the PARIS registry suggested that the proportions of patients with DAPT coverage after the DES implantation at 1-year and 2-year follow-up were 76.7% and 42.7%, respectively in 15 clinical sites in US and Europe [13]
The patients were divided into 3 groups according to DAPT duration: 1 year (>13 months)
Summary
Dual antiplatelet therapy (DAPT), i.e., aspirin in combination with a P2Y12 antagonist, is an essential component of the treatment of patients undergoing percutaneous coronary intervention (PCI) especially with the drug-eluting stent (DES) [1]. A minimum DAPT duration of 12 months after DES implantation had been recommended by guidelines, irrespective of reported clinical research results [1,2]. A reduced DAPT duration has been considered safe and with the reduced risk of bleeding complications [4,5,6,7], the ST longer than 12 months after the DES implantation was still observed [8]. Updated guidelines with adjusted DAPT duration after DES implantation has been recommended according to the patients’ bleeding and ischemic risks [9,10,11]. The DAPT duration after the DES implantation is more complicated, determined by both physicians’ comprehension of the complex guidelines and the patients’ compliance [12]. We analyzed a large amount of cases in the biggest cardiovascular center in China to investigate the DAPT duration and identify associated factors after the DES implantation
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