Dual antiplatelet therapy beyond 12 months versus for 12 months after drug-eluting stents for acute myocardial infarction
Dual antiplatelet therapy beyond 12 months versus for 12 months after drug-eluting stents for acute myocardial infarction
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DOI：
10.1016/j.jjcc.2019.06.006
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发表时间：
2020-01-01
影响因子：
2.5
通讯作者：
Hwang, Jin Yong
中科院分区：
文献类型：
--
作者：
Sim, Doo Sun;Jeong, Myung Ho;Hwang, Jin Yong
背景：急性冠状动脉综合征后双联抗血小板治疗（DAPT）的最佳持续时间仍不确定。本研究探讨了药物洗脱支架（DES）治疗急性心肌梗死（MI）后12个月以上DAPT的获益。方法：从韩国急性心肌梗死登记处-国立卫生研究院数据库，对6199例DES（第二代DES 98%）后12个月DAPT治疗无缺血或出血事件的患者进行了分析。主要终点是主要不良心血管和脑血管事件（MACCE），包括12至24个月期间的全因死亡、MI或缺血性卒中。使用治疗加权的逆概率进行调整后，接受DAPT超过12个月的患者（n = 4795）与接受12个月DAPT治疗的患者（n = 1404）相比，MACCE发生率相似（1.3% vs. 1.0%，HR：1.32，95% CI：0.71-2.45，p = 0.378）。两组的死亡率（0.1% vs. 0.1%）、MI（0.8% vs. 0.6%）、支架内血栓形成（0.1% vs. 0.2%）、缺血性卒中（0.4% vs. 0.2%）和大出血（0.1% vs. 0.1%）无显著差异。DAPT超过12个月的净不良临床事件发生率为1.4%，DAPT超过12个月的净不良临床事件发生率为1.1%（p = 0.466）。结论：与DAPT超过12个月相比，在主要使用第二代DES治疗的急性MI真实患者中，DAPT超过12个月并没有降低MACCE的风险。两种治疗之间的大出血和净不良临床事件发生率无显著差异。(C)2019年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: The optimal duration of dual antiplatelet therapy (DAPT) after acute coronary syndrome remains uncertain. This study investigated the benefit of DAPT beyond 12 months after drug-eluting stents (DES) for acute myocardial infarction (MI).Methods: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 6199 patients treated with DAPT for 12 months after DES (second-generation DES 98%) without ischemic or bleeding events were analyzed. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), a composite of death from any cause, MI, or ischemic stroke during the period from 12 to 24 months.Results: After adjustment using inverse probability of treatment weighting, patients who received DAPT beyond 12 months (n = 4795), compared to patients treated with 12-month DAPT (n = 1404), had a similar incidence of MACCE (1.3% vs. 1.0%, HR: 1.32, 95% CI: 0.71-2.45, p = 0.378). The 2 groups did not differ significantly in the rates of death (0.1% vs. 0.1%), MI (0.8% vs.0.6%), stent thrombosis (0.1% vs. 0.2%), ischemic stroke (0.4% vs. 0.2%), and major bleeding (0.1% vs. 0.1%). The rate of net adverse clinical events was 1.4% with DAPT beyond 12 months and 1.1% with 12-month DAPT (p = 0.466).Conclusions: DAPT beyond 12 months, as compared with 12-month DAPT, in real-world patients with acute MI treated predominantly with second-generation DES did not reduce the risk of MACCE. The rates of major bleeding and net adverse clinical events did not differ significantly between the 2 treatments. (C) 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.