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Vol. 76. Issue 4.
Pages 245-252 (April 2023)
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Vol. 76. Issue 4.
Pages 245-252 (April 2023)
Original article
Dual antiplatelet therapy after percutaneous coronary intervention for left main coronary artery disease
Tratamiento antiagregante plaquetario doble tras la intervención coronaria percutánea del tronco coronario izquierdo
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Sungsoo Choa,, Do-Yoon Kangb,, Jung-Sun Kimc,
Corresponding author
kjs1218@yuhs.ac

Corresponding author.
, Duk-Woo Parkb,
Corresponding author
dwpark@amc.seoul.kr

Corresponding author.
, In-Soo Kimd, Tae Soo Kange, Jung-Min Ahnb, Pil Hyung Leeb, Soo-Jin Kangb, Seung-Whan Leeb, Young-Hak Kimb, Cheol Whan Leeb, Seong-Wook Parkb, Seung-Jun Leec, Sung-Jin Hongc, Chul-Min Ahnc, Byeong-Keuk Kimc, Young-Guk Koc, Donghoon Choic, Yangsoo Jangf..., Myeong-Ki Hongc, Seung-Jung ParkbVer más
a Department of Cardiology, Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Gyeonggi-do, Republic of Korea
b Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
c Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
d Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
e Division of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Choongcheongnam-do, Republic of Korea
f Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
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Abstract
Introduction and objectives

There are scarce data on the optimal duration and prognostic impact of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents for left main coronary artery (LMCA) disease. The aim of this study was to investigate the practice pattern and long-term prognostic effect of DAPT duration in patients undergoing PCI with second-generation drug-eluting stents for LMCA disease.

Methods

Using individual patient-level data from the IRIS-MAIN and KOMATE registries, 1827 patients undergoing PCI with second-generation drug-eluting stents for LMCA disease with valid information on DAPT duration were included. The efficacy outcome was major adverse cardiovascular events (MACE, a composite of cardiac death, myocardial infarction, and stent thrombosis) and the safety outcome was TIMI major bleeding.

Results

DAPT duration was <6 months (n=273), 6 to 12 months (n=477), 12 to 24 months (n=637), and ≥ 24 months (n=440). The median follow-up duration was 3.9 [interquartile range, 3.01-5.00] years. Prolonged DAPT duration was associated with lower incidences of MACE. In multigroup propensity score analysis, adjusted HR for MACE were significantly higher for DAPT <6 months and DAPT 6 to 12 months than for DAPT 12 to 24 months (HR, 4.51; 95%CI, 2.96-6.88 and HR 1.92; 95%CI, 1.23-3.00). There was no difference in HR for major bleeding among the assessed groups.

Conclusions

DAPT duration following PCI for LMCA disease is highly variable. Although the duration of DAPT should be considered in the context of the clinical situation of each patient, <12 months of DAPT was associated with higher incidence of MACE. Registration identifiers: NCT01341327; NCT03908463.

Keywords:
Dual antiplatelet therapy
Left main coronary artery disease
Drug-eluting stents
Abreviaturas:
DAPT
DES
LMCA
MACE
PCI
ST
Resumen
Introducción y objetivos

Son escasos los datos sobre la duración y el impacto pronóstico del tratamiento antiagregante plaquetario doble (TAPD) tras una intervención coronaria percutánea (ICP) del tronco coronario izquierdo (TCI) con stents farmacoactivos de segunda generación. El objetivo de este estudio es investigar los patrones de prescripción y el efecto pronóstico a largo plazo de la duración del TAPD en pacientes sometidos a ICP del TCI con stents farmacoactivos segunda generación.

Métodos

A partir de los datos individuales de los registros IRIS-MAIN y KOMATE, se incluyó a 1.827 pacientes sometidos a ICP del TCI con stents farmacoactivos de segunda generación de los que hubiese información válida sobre la duración del TAPD. El objetivo de eficacia fue la aparición de eventos cardiovasculares adversos mayores (MACE) (un combinado de muerte cardiaca, infarto de miocardio y trombosis del stent) y el de seguridad fue la presencia de hemorragia mayor según TIMI.

Resultados

Las duraciones del TAPD fueron <6 meses (n=273), de 6-12 meses (n=477), de 12-24 meses (n=637) y ≥ 24 meses (n=440). La mediana de la duración del seguimiento fue de 3,9 [intervalo intercuartílico, 3,01-5,00] años. El TAPD prolongado se asoció con menor incidencia de MACE. En el análisis de puntuación de propensión multigrupo, las HR ajustadas de los MACE fueron significativamente mayores con los TAPD de menos de 6 meses y de 6-12 meses (HR=4,51; IC95%, 2,96-6,88) frente al TAPD de 12-24 meses (HR=1,92; IC95%, 1,23-3,00). No hubo diferencias en la HR de hemorragia mayor entre los grupos evaluados.

Conclusiones

La duración del TAPD tras la ICP para la enfermedad del TCI es muy variable. Aunque debe considerarse en función de la situación clínica de cada paciente, un TAPD de menos de 12 meses se asoció con mayor incidencia de MACE.

Palabras clave:
Tratamiento antiagregante plaquetario doble
Enfermedad del tronco coronario izquierdo
Stents farmacoactivos

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