Lesion Complexity and Outcomes of Extended Dual Antiplatelet Therapy After Percutaneous Coronary Intervention.
Lesion Complexity and Outcomes of Extended Dual Antiplatelet Therapy After Percutaneous Coronary Intervention.
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DOI：
10.1016/j.jacc.2017.09.011
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发表时间：
2017-10-31
影响因子：
24
通讯作者：
DAPT Study Investigators
中科院分区：
文献类型：
--
作者：
Yeh RW;Kereiakes DJ;Steg PG;Cutlip DE;Croce KJ;Massaro JM;Mauri L;DAPT Study Investigators
Subjects undergoing coronary stenting with complex lesion anatomy may experience different risks and benefits with prolonged dual antiplatelet therapy. The authors assessed the effect of 30 versus 12 months of dual antiplatelet therapy after percutaneous coronary intervention (PCI) based on the presence or absence of anatomically-complex target lesions. In the Dual Antiplatelet Therapy (DAPT) Study, combined myocardial infarction (MI) or stent thrombosis and moderate/severe bleeding were assessed in enrolled (N=25416) and randomized (N=11554) subjects. Complex lesions had any of the following characteristics: unprotected left main, >2 lesions per vessel, length ≥30 mm, bifurcation with side branch ≥2.5 mm, vein bypass graft, or thrombus-containing lesion. Events were evaluated according to increasing number of complexity characteristics and compared according to DAPT score. Enrolled subjects with more complex target lesions had higher rates of MI or stent thrombosis in the first 12 months after PCI (3.9% vs. 2.4%, P<0.001). Among those event-free at 12 months, rates of MI or stent thrombosis between 12–30 months were similar between those with versus without complex anatomy (3.5% vs. 2.9%, P=0.07). Reduction of MI or stent thrombosis with continued thienopyridine beyond 12 months vs. placebo was similar for subjects with (2.5% vs. 4.5%, HR 0.55, 95% CI 0.38–0.79; P=0.001) and without (2.0% vs. 3.8%, HR 0.52, 95% CI 0.39–0.69; P<0.001) anatomic complexity (Pinteraction=0.81), as was increase in moderate/severe bleeding (Pinteraction=0.44). Among subjects with anatomic complexity, those with DAPT scores ≥2 randomized to continued thienopyridine had greater reductions in MI or stent thrombosis (3.0% vs. 6.1%; P<0.001) compared with subjects with scores <2 (1.7%= vs. 2.3%, P=0.42, P comparing risk differences=0.03). Complex target-lesion anatomy is associated with increased ischemic events, particularly within the first year after PCI. Among those without events in the first 12 months, the benefits of extending dual antiplatelet therapy were similar in subjects with and without complex lesions. High DAPT score identified those experiencing the most benefit from extended treatment among patients with and without complex anatomy. Subjects undergoing coronary stenting with complex lesion anatomy may experience different risks and benefits with prolonged dual antiplatelet therapy. In this subgroup analysis of the Dual Antiplatelet Therapy (DAPT) Study comparing the effect of 30 versus 12 months of dual antiplatelet therapy after percutaneous coronary intervention, complex target-lesion anatomy was associated with increased ischemic events, particularly within the first year. Among those without events after 12 months, the benefits of extending therapy were similar in subjects with and without complex lesions. High DAPT score identified those experiencing the most benefit from extended treatment among patients with and without complex anatomy.
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裸金属或洗脱冠状动脉支架后的抗血小板治疗持续时间：双重抗血小板治疗随机临床试验。
影响因子：
120.7
作者：
Kereiakes, Dean J.;Yeh, Robert W.;Massaro, Joseph M.;Driscoll-Shempp, Priscilla;Cutlip, Donald E.;Steg, P. Gabriel;Gershlick, Anthony H.;Darius, Harald;Meredith, Ian T.;Ormiston, John;Tanguay, Jean Francois;Windecker, Stephan;Garratt, Kirk N.;Kandzari, David E.;Lee, David P.;Simon, Daniel I.;Iancu, Adrian Corneliu;Trebacz, Jaroslaw;Mauri, Laura
通讯作者：
Mauri, Laura
影响因子：
11.3
作者：
Hermiller, James B.;Krucoff, Mitchell W.;Mauri, Laura
通讯作者：
Mauri, Laura
影响因子：
37.8
作者：
Cutlip, Donald E.;Windecker, Stephan;Serruys, Patrick W.
通讯作者：
Serruys, Patrick W.
影响因子：
4.8
作者：
Mauri, Laura;Kereiakes, Dean J.;Massaro, Joseph M.
通讯作者：
Massaro, Joseph M.
影响因子：
37.8
作者：
Mehran, Roxana;Rao, Sunil V.;White, Harvey
通讯作者：
White, Harvey