Efficacy and Safety of Guideline-Recommended Risk Score-Directed Dual Antiplatelet Therapy After 2nd-Generation Drug-Eluting Stents

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  • Jang Ji-Yong
    Division of Cardiology, National Health Insurance Service Ilsan Hospital
  • Lee Byoung-Kwon
    Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine
  • Kim Jung-Sun
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Shin Dong-Ho
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Hong Sung-Jin
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Ahn Chul-Min
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Kim Byeong-Keuk
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Ko Young-Guk
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Choi Donghoon
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Hong Myeong-Ki
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine Cardiovascular Research Institute, Yonsei University College of Medicine
  • Park Kyung Woo
    Division of Cardiology, Seoul National University Hospital School of Medicine, Seoul National University College of Medicine
  • Gwon Hyeon-Cheol
    Division of Cardiology, Samsung Medical Centre, Sungkyunkwan University College of Medicine
  • Kim Hyo-Soo
    Division of Cardiology, Seoul National University Hospital School of Medicine, Seoul National University College of Medicine
  • Kwon Hyuck Moon
    Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine
  • Jang Yangsoo
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine Cardiovascular Research Institute, Yonsei University College of Medicine

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<p>Background:Evaluate the safety and efficacy of guideline-recommended risk score-directed dual antiplatelet therapy (GD-DAPT) based on THE PRECISE-DAPT score after 2nd-generation drug-eluting stent (DES) implantation.</p><p>Methods and Results:We analyzed 5,131 patients pooled from 4 clinical trials. Patients were divided into 3 groups according to current recommendations on the duration of DAPT and their actual DAPT duration: GD-DAPT (n=2,183), shorter DAPT (n=1,540), longer DAPT (n=1,408). The primary endpoint was the rate of net adverse clinical events (NACE) during the first 12 months. The secondary endpoints were ischemic or bleeding events. Overall, GD-DAPT did not affect NACE (1.2% vs. 1.2% for shorter DAPT and 1.7% for longer DAPT) or bleeding events (0.6% vs. 0.5% and 0.9%), and there were fewer ischemic events (2.8% vs. 4.4% and 4.0%, P=0.03) than with shorter DAPT. Especially in acute coronary syndrome (ACS) patients, GD-DAPT had fewer NACE (1.5% vs. 1.4% and 4.2%; P=0.006) and bleeding events (0.8% vs. 0.5% and 2.8%; P=0.001) than longer DAPT as well as fewer ischemic events (2.8% vs. 4.4% and 4.7%; P=0.03) than shorter DAPT.</p><p>Conclusions:GD-DAPT did not affect NACE or bleeding events and reduced the number of ischemic events at 12 months compared with shorter DAPT. For ACS, GD-DAPT was associated with favorable outcomes compared with non-GD-DAPT. Therefore, GD-DAPT may optimize efficacy and safety.</p>

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  • Circulation Journal

    Circulation Journal 84 (2), 161-168, 2020-01-24

    一般社団法人 日本循環器学会

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