Rationalizing Duration of Dual Antiplatelet Therapy After Coronary Stenting

冠状动脉支架置入术后双联抗血小板治疗持续时间的合理化

• 批准号: 10425216
• 负责人: Scott Kinlay
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10425216
• 关键词: Antiplatelet Drugs; Applications Grants; Aspirin; Atherosclerosis; Cardiac; Cardiac Catheterization Procedures; Cardiovascular system; Catheterization; Cessation of life; Clinical; Clinical Trials; Conflict (Psychology); Coronary; Coronary Artery Bypass; Data; Databases; Drug usage; Early Intervention; Event; Funding; Generations; Grant; Guidelines; Health; Health system; Hemorrhage; Hospitals; Laboratories; Medicare; Metals; Myocardial Infarction; New Agents; Observational Study; Operative Surgical Procedures; Outcome; Patients; Pharmaceutical Preparations; Randomized Controlled Trials; Records; Recurrence; Regimen; Reporting; Risk; Risk Factors; Sample Size; Stents; Stroke; Time; Treatment Cost; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; administrative database; base; cerebrovascular; clopidogrel; cohort; high risk; high risk population; indexing; inhibitor/antagonist; mortality; mortality risk; percutaneous coronary intervention; prevent; research study; restenosis; secondary endpoint; stent thrombosis; therapy duration; thienopyridine; treatment duration

In 2015, over 12,000 Veterans had percutaneous coronary interventions (PCI) in one of the 78 Veterans Affairs (VA) cardiac catheterization laboratories throughout the nation. Most of these PCIs used drug eluting stents, which have lower rates of restenosis and need for repeat interventions than earlier bare metal stents. However, drug eluting stents require longer dual antiplatelet therapy (DAPT) with aspirin and a thienopyridine inhibitor to prevent stent thrombosis and myocardial infarction. Current guidelines recommend 12 months DAPT therapy based on studies of 1st-generation drug eluting stents. However, the largest study to assess DAPT duration suggested less myocardial infarction and stent thrombosis with longer treatment up to 3 years after PCI. More recent studies using newer 2nd-generation drug eluting stents reach conflicting conclusions about the duration of DAPT ranging from 6-12 months to as long as 3 years. Currently, the 2nd-generation drug eluting stents have replaced 1st-generation stents. Furthermore, newer more potent antiplatelet agents may offer lower risks of myocardial infarction and stent thrombosis, but have higher risks of bleeding. The question of duration of DAPT is particularly important in Veterans, as they have 2-4 times the risk of myocardial infarction and death after PCI than patients in the largely non-VA research studies of DAPT duration. This MERIT grant proposal study will identify Veterans receiving PCI between 2012-2016 from the VA Cardiovascular Assessment Reporting and Tracking (CART) database which records procedural details of all PCIs in the VA Health System. We will merge this data with VA administrative databases containing information on drug use and duration, and clinical outcomes of death, myocardial infarction, repeat coronary revascularization (PCI or coronary bypass surgery), stroke, and major bleeding from 2-6 years after the index PCI. We will also merge data on these outcomes from non-VA hospitals using the CMS/Medicare database, and cause specific mortality using National Death Index data. The primary aim of the study will assess the risk of death or myocardial infarction from 6 months after PCI to up to 6 years after PCI. We will compare outcomes in Veterans receiving DAPT for 6-12 months versus more than 12 months therapy to assess whether shorter durations are associated with better outcomes with the newer 2nd-generation drug eluting stents. This grant will also compare the newer DAPT agents (ticagrelor and prasugrel) versus clopidogrel, to examine whether these newer agents are associated with less death or myocardial infarction or more major bleeding. In addition the study will develop a simple score to identify Veterans who may benefit from longer DAPT treatment, versus those who could safely use shorter durations of DAPT therapy. Finally, we will use this data to estimate samples sizes for a definitive clinical trial of the DAPT duration in Veterans receiving PCI with 2nd- generation stents.

2015年，在78个退伍军人事务中心之一，超过12,000名退伍军人接受了经皮冠状动脉介入治疗（PCI）

项目成果

Patient and limb outcomes 10 years after endovascular revascularization of the superficial femoral artery for peripheral artery disease: The Boston Femoral Artery Endovascular Revascularization Outcomes (Boston FAROUT) study.

• DOI: 10.1177/1358863x231174052
• 发表时间: 2023-08
• 期刊: Vascular medicine (London, England)

A systematic review of patient-reported outcome measures patients with chronic limb-threatening ischemia.

• DOI: 10.1016/j.jvs.2021.11.057
• 发表时间: 2022-05
• 期刊: JOURNAL OF VASCULAR SURGERY
• 影响因子: 4.3
• 作者: Goodney, Philip;Shah, Samir;Hu, Yiyuan David;Suckow, Bjoern;Kinlay, Scott;Armstrong, David G.;Geraghty, Patrick;Patterson, Megan;Menard, Matthew;Patel, Manesh R.;Conte, Michael S.
• 通讯作者: Conte, Michael S.

Risk of Mortality Related to Recurrent Limb Events After Endovascular Revascularization of the Superficial Femoral Artery for Peripheral Artery Disease: The Boston Femoral Artery Endovascular Revascularization Outcomes (Boston FAROUT) Study.

因外周动脉疾病进行股浅动脉血管内血运重建后，与复发性肢体事件相关的死亡风险：波士顿股动脉血管内血运重建结果（波士顿 FAROUT）研究。

• DOI: 10.1016/j.amjcard.2023.07.172
• 发表时间: 2023
• 期刊: The American journal of cardiology
• 作者: Evans,Peter;Sobieszczyk,Piotr;Eisenhauer,AndrewC;Ostrowski,Simon;Todoran,ThomasM;Kinlay,Scott
• 通讯作者: Kinlay,Scott

Antithrombotic treatment following percutaneous coronary intervention in patients with high bleeding risk.

• DOI: 10.1097/hco.0000000000001075
• 发表时间: 2023-11-01
• 期刊: Current opinion in cardiology
• 影响因子: 2.3

Reproducibility and validity of a novel invasive method of assessing peripheral microvascular vasomotor function.

评估外周微血管血管舒缩功能的新型侵入性方法的重现性和有效性。

• DOI: 10.1371/journal.pone.0211152
• 发表时间: 2019
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Kinlay,Scott;Bundy,Mariah;Chin,Melissa;Tobin,Desiree;Quinn,Margot;Do,Jacquelyn-My;Johnson,Shannon;Temiyasathit,Sara;Ly,Samantha
• 通讯作者: Ly,Samantha