Prolonged dual antiplatelet therapy after drug-eluting stent implantation improves long-term prognosis for acute coronary syndrome:five-year results from a large cohort study

作     者：Jing-jing Xu Si-da Jia Lin Jiang Ying Song Pei Zhu De-shan Yuan Yi Yao Xue-yan Zhao Jian-xin Li Yue-jin Yang Shu-bin Qiao Bo Xu Run-lin Gao Jin-qing Yuan Jing-jing Xu;Si-da Jia;Lin Jiang;Ying Song;Pei Zhu;De-shan Yuan;Yi Yao;Xue-yan Zhao;Jian-xin Li;Yue-jin

作者机构：Department of CardiologyFuwai Hospital and Cardiovascular InstituteNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China 

出 版 物：《World Journal of Emergency Medicine》 (世界急诊医学杂志（英文）)

年 卷 期：2023年第14卷第1期

页      面：25-30页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：supported by the National High Level Hospital Clinical Research Funding(2022-GSP-QN-1) the National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences(NCRC2020013) the National Natural Science Foundation of China(81900323) China International Exchange and Promotion Association for Medical and Healthcare Investigator Sponsored Study(CN174125,DIREGL08735-DAPT)。 

主　　题：Dual antiplatelet therapy Acute coronary syndrome Drug-eluting stent implantation 

摘      要：BACKGROUND:To investigate the most appropriate dual antiplatelet therapy(DAPT)duration for patients with acute coronary syndrome(ACS)after drug-eluting stent(DES)implantation in the largest cardiovascular center of China.METHODS:We enrolled 5,187 consecutive patients with ACS who received DES from January to December 2013.Patients were divided into four groups based on DAPT duration:standard DAPT group(11-13 months,n=1,568)and prolonged DAPT groups(13-18 months[n=308],18-24 months[n=2,125],and24 months[n=1,186]).Baseline characteristics and 5-year clinical outcomes were recorded.RESULTS:Baseline characteristics were similar across the four groups.Among the four groups,those with prolonged DAPT(18-24 months)had the lowest incidence of major adverse cardiovascular and cerebrovascular events(MACCEs)(14.1%vs.11.7%vs.9.6%vs.24.2%,P0.001),all-cause death(4.8%vs.3.9%vs.2.1%vs.2.6%,P0.001),cardiac death(3.1%vs.2.6%vs.1.4%vs.1.9%,P=0.004),and myocardial infarction(MI)(3.8%vs.4.2%vs.2.5%vs.5.8%,P0.001).The incidence of bleeding was not different among the four groups(9.9%vs.9.4%vs.11.0%vs.9.4%,P=0.449).Cox multivariable analysis showed that prolonged DAPT(18-24 months)was an independent protective factor for MACCEs(hazard ratio[HR]0.802,95%confidence interval[CI]0.729-0.882,P0.001),all-cause death(HR 0.660,95%CI 0.547-0.795,P0.001),cardiac death(HR 0.663,95%CI 0.526-0.835,P0.001),MI(HR 0.796,95%CI 0.662-0.957,P=0.015),and target vessel revascularization(HR 0.867,95%CI 0.755-0.996,P=0.044).Subgroup analysis for high bleeding risk showed that prolonged DAPT remained an independent protective factor for all-cause death and MACCEs.CONCLUSION:For patients with ACS after DES,appropriately prolonging the DAPT duration may be associated with a reduced risk of adverse ischemic events without increasing the bleeding risk.