Impact of Six Versus 12 Months of Dual Antiplatelet Therapy in Patients With Drug- Eluting Stent Implantation After Risk Stratification With the Residual SYNTAX Score: Results From a Secondary Analysis of the I-LOVE- IT 2 Trial
Impact of Six Versus 12 Months of Dual Antiplatelet Therapy in Patients With Drug- Eluting Stent Implantation After Risk Stratification With the Residual SYNTAX Score: Results From a Secondary Analysis of the I-LOVE- IT 2 Trial
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DOI：
10.1002/ccd.26948
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发表时间：
2017-03-01
影响因子：
2.3
通讯作者：
Han, Yaling
中科院分区：
文献类型：
--
作者：
Qiu, Miaohan;Li, Yi;Han, Yaling
背景资料：药物洗脱支架（DES）植入后双重抗血小板治疗（DAPT）的最佳持续时间尚未确定，特别是对于那些术后心脏事件风险高的患者。目的：本研究旨在根据剩余SYNTAX评分（rSS）的风险分层，研究DES植入后6个月与12个月DAPT的影响。研究方法：根据rSS状态（低rSS [rSS = 0，n = 1474] vs高rSS [ rSS> 0，n = 1263]）和DAPT持续时间（6个月vs 12个月）对I-LOVE-IT 2试验中的共计2737例患者进行分组。主要终点为12个月靶病变失败（TLF），主要次要终点为12个月净不良临床事件（NACE）和大出血。结果如下：高rSS患者12个月时TLF（5.2 vs. 7.4%，P = 0.01）和NACE（9.2 vs. 13.4%，P < 0.001）的发生率显著高于低rSS患者。地标分析显示，在高rSS患者中，PCI后6 - 12个月内，与6个月DAPT相比，12个月DAPT与TLF（3.0% vs. 1.6%，P = 0.08）和NACE（7.0 vs. 4.4%，P = 0.054）风险略低相关。在低rSS组和高rSS组中，DAPT持续时间不同的患者出血风险相似。结论：高rSS患者在DES植入后12个月时TLF和NACE的风险增加。对于高rSS患者，在PCI后6至12个月内减少不良事件方面，10个月DAPT可能上级6个月DAPT，而无过度出血风险。(C)2017 Wiley Periodicals，Inc.
Background: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation remains undetermined, especially for those at high risk of cardiac events postprocedure. Objectives: This study was aimed to investigate the impact of 6 versus 12 months of DAPT after DES implantation based on risk stratification with the residual SYNTAX score (rSS). Methods: A total of 2737 patients in the I-LOVE-IT 2 trial were grouped according to rSS status (low rSS [rSS = 0, n = 1474] versus high rSS [ rSS > 0, n = 1263]) and DAPT duration (6 months vs. 12 months). The primary endpoint was 12-month target lesion failure (TLF), and the major secondary endpoints were 12-month net adverse clinical events (NACE) and major bleeding. Results: Incidences of TLF (5.2 vs. 7.4%, P = 0.01) and NACE (9.2 vs. 13.4%, P < 0.001) at 12 months were significantly higher in patients with high rSSs compared with patients with low rSSs. Landmark analysis showed that, in patients with high rSS, 12-month DAPT was associated with slightly lower risks of TLF (3.0% vs. 1.6%, P = 0.08) and NACE (7.0 vs. 4.4%, P = 0.054) compared with 6-month DAPT within 6 to 12 months after PCI. Patients with different DAPT durations had similar risks of bleeding both in the low and high rSS groups. Conclusions: Patients with high rSSs have an increased risk of TLF and NACE at 12 months after DES implantation. Twelve-month DAPT might be superior to 6-month DAPT in patients with high rSS for reducing adverse events within 6 to 12 months after PCI without excessive risk of bleeding. (C) 2017 Wiley Periodicals, Inc.