Prolonging dual antiplatelet therapy improves the long-term prognosis in patients with diabetes mellitus undergoing complex percutaneous coronary intervention

作     者：Jing-Jing XU Si-Da JIA Pei ZHU Ying SONG De-Shan YUAN Xue-Yan ZHAO Yi YAO Lin JIANG Jian-Xin LI Yin ZHANG Lei SONG Run-Lin GAO Ya-Ling HAN Jin-Qing YUAN 

作者机构：Department of CardiologyNational Clinical Research Center for Cardiovascular DiseasesNational Center for Cardiovascular DiseasesState Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of CardiologyGeneral Hospital of Northern Theater CommandShenyangChina 

出 版 物：《Journal of Geriatric Cardiology》 (老年心脏病学杂志（英文版）)

年 卷 期：2023年第20卷第8期

页      面：586-595页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：supported by the National High Level Hospital Clinical Research Fund(2022-GSP-QN-1) the Young Talent Program of the Academician Fund(YS-2022-002) the National Key Research and Development Program of China(2016YFC130130&2016YFC1301301) the National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences(NCRC2020013) 

主　　题：patients coronary mellitus 

摘      要：OBJECTIVE To investigate the optimal duration of dual antiplatelet therapy(DAPT)in patients with diabetes mellitus(DM)requiring complex percutaneous coronary intervention(PCI).METHODS A total of 2403 patients with DM who underwent complex PCI from January to December 2013 were consecutively enrolled in this observational cohort study and divided according to DAPT duration into a standard group(11-13 months,n=689)and two prolonged groups(13-24 months,n=1133;24 months,n=581).RESULTS Baseline characteristics,angiographic findings,and complexity of PCI were comparable regardless of DAPT *** incidence of major adverse cardiac and cerebrovascular event was lower when DAPT was 13-24 months than when it was 11-13 months or24 months(4.6%vs.8.1%vs.6.0%,P=0.008),as was the incidence of all-cause death(1.9%vs.4.6%vs.2.2%,P=0.002)and cardiac death(1.0%vs.3.0%vs.1.2%,P=0.002).After adjustment for confounders,DAPT for 13-24 months was associated with a lower risk of major adverse cardiac and cerebrovascular event[hazard ratio(HR)=0.544,95%CI:0.373-0.795]and all-cause death(HR=0.605,95%CI:0.387-0.944).DAPT for24 months was associated with a lower risk of all-cause death(HR=0.681,95%CI:0.493-0.942)and cardiac death(HR=0.620,95%CI:0.403-0.952).The risk of major bleeding was not increased by prolonging DAPT to 13-24 months(HR=1.356,95%CI:0.766-2.401)or24 months(HR=0.967,95%CI:0.682-1.371).CONCLUSIONS For patients with DM undergoing complex PCI,prolonging DAPT might improve the long-term prognosis by reducing the risk of adverse ischemic events without increasing the bleeding risk.