Abstract
Guidelines recommend shorter duration (1–12 months) for dual antiplatelet therapy (DAPT) in the second-generation drug-eluting stent (DES) era. However, whether shorter DAPT duration affects stent strut conditions and neointimal characteristics at mid-term follow-up remains uncertain. Therefore, we studied the relation between DAPT duration and vascular healing response as assessed by optical coherence tomography (OCT). This study was retrospective observational study. Participants comprised 64 patients who underwent serial OCT at both 9 and 18 months after DES implantation. All patients received DAPT until the 9-month follow-up then were divided into two groups: 49 patients who continued DAPT (longer DAPT group); and 15 patients who stopped taking the P2Y12 inhibitor and were treated with aspirin alone (shorter DAPT group) at the 18-month follow-up. Using OCT, we evaluated and compared stent strut conditions and neointimal characteristics between groups at both 9 and 18 months after stent implantation. Baseline clinical and procedural parameters were mostly similar between groups. At the 18-month follow-up, no in-stent thrombus assessed by OCT was observed in either group. No significant differences in OCT characteristics or measurements of neointima were seen between groups at 9- or 18-month follow-ups. Neointimal volume increased from 9 to 18 months in both groups, with a similar degree of neointimal proliferation in both groups (shorter DAPT group, 0.23 ± 0.29 mm3/mm; longer DAPT group, 0.19 ± 0.27 mm3/mm; P = 0.56). In conclusion, interrupting DAPT 9 months after second-generation DES implantation did not affect the development of in-stent thrombus, neointimal proliferation or stent strut coverage at 18-month follow-up compared with continuing DAPT.
Highlights
Stent implantation has developed as a treatment for coronary artery disease
We evaluated the neointimal characteristics at the minimum lumen area (MLA) site of the stented segment and classified into four patterns: homogeneous, heterogeneous, layered and neoatherosclerosis (NA) [13]
This study was retrospective observational study and guidelines of the Japanese circulation society recommended that dual antiplatelet therapy (DAPT) duration after Drugeluting stents (DES) implantation was more than 12 months when analyzed cases underwent percutaneous coronary intervention (PCI) [17]
Summary
Stent implantation has developed as a treatment for coronary artery disease. Bare metal stents (BMS) successfully restore the acute vessel lumen, but long-term outcomes are often compromised by in-stent restenosis (ISR). In the second-generation DES era, some clinical trials suggested the superiority of DES over BMS even with in-stent thrombosis and patients with the acute coronary syndrome (ACS) [1,2,3]. Some recent papers have shown that shorter DAPT duration did not increase thrombotic events, with the use of second-generation DES [1, 5, 6]. The guideline recommends a shorter duration of DAPT after DES implantation, for patients at high risk of bleeding [7, 8]. Differences in stent strut condition between patients with shorter and longer DAPT administration at mid-term after DES implantation remain unclear. The purpose of this study was to evaluate the influence of DAPT duration on neointimal condition after second-generation DES implantation using optical coherence tomography (OCT)
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