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Circ Cardiovasc Interv. 2018 Jul;11(7):e005849. doi: 10.1161/CIRCINTERVENTIONS.117.005849.

Benefit of Prolonged Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stent for Coronary Bifurcation Lesions: Results From the Coronary Bifurcation Stenting Registry II.

Author information

1
Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, South Korea (W.J.J., W.J.C., J.H.O.).
2
Division of Cardiology, Yonsei University Wonju College of Medicine, South Korea (S.G.A., J.H.Y.).
3
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (Y.B.S., S.-H.C., S.W.C., B.S.K., H.-C.G., J.-Y.H.).
4
Division of Cardiology, Seoul National University Hospital, South Korea (B.-K.K., H.-S.K.).
5
Division of Cardiology, Korea University Anam Hospital, Seoul (C.W.Y.).
6
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.S.J.).
7
Division of Cardiology, Ajou University Hospital, Suwon, South Korea (S.-J.T.).
8
Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, South Korea (S.Y.L.). jyhahn@skku.edu im2pci@gmail.com.
9
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (Y.B.S., S.-H.C., S.W.C., B.S.K., H.-C.G., J.-Y.H.). jyhahn@skku.edu im2pci@gmail.com.

Abstract

BACKGROUND:

Whether prolonged dual antiplatelet therapy (DAPT) improves clinical outcomes after percutaneous coronary intervention for coronary bifurcation lesion is uncertain.

METHODS AND RESULTS:

We evaluated 2082 patients who were treated with drug-eluting stent for bifurcation lesions and were event free (no death, myocardial infarction [MI], cerebrovascular accident, stent thrombosis, or any revascularization) at 12 months after the index procedure. Patients were divided into 2 groups: DAPT ≥12-month group (n=1776) and DAPT <12-month group (n=306). Primary outcome was all-cause death or MI. At 4 years after the index procedure, death or MI occurred less frequently in the DAPT ≥12-month group than the DAPT <12-month group (2.8% versus 12.3%; adjusted hazard ratio, 0.21; 95% confidence interval, 0.13-0.35; P<0.001). After propensity score matching, incidence of death or MI was still lower in the DAPT ≥12-month group than the DAPT <12-month group (2.6% versus 12.3%; adjusted hazard ratio, 0.22; 95% confidence interval, 0.12-0.38; P<0.001). In subgroup analysis, the treatment effect of prolonged DAPT was consistent across subgroups regardless of lesion location, stenting technique, or type of used drug-eluting stent.

CONCLUSIONS:

The risk of all-cause death or MI was significantly lower in the ≥12-month DAPT group than the <12-month DAPT group after percutaneous coronary intervention for bifurcation lesion using drug-eluting stent. Our results suggest that prolonged DAPT may improve long-term clinical outcomes after percutaneous coronary intervention for bifurcation lesions.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT01642992.

KEYWORDS:

drug-eluting stents; incidence; myocardial infarction; percutaneous coronary intervention; thrombosis

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