Author + information
- Hiromi Muranishi1,
- Kyohei Yamaji2,
- Yuhei Yamaji3,
- Kenji Ando3,
- Kazushige Kadota4,
- Hirooki Higami5,
- Kazuya Kawai6,
- Takashi Tamura7,
- Hiroki Sakamoto8,
- Mamoru Toyofuku9,
- Takeshi Morimoto10 and
- Takeshi Kimura11
- 1Japanese Red Cross Society Otsu Hospital, Otsu, Japan
- 2Kitakyushu, Japan
- 3Kokura Memorial Hosiptal
- 4Kurashiki Central Hospital, Kurashiki, Japan
- 5Otsu Red cross, Otsu, Japan
- 6Chikamori Hospital, Kochi, Japan
- 7Japanese Red Cross Society Wakayama Medical Center
- 8Shizuoka General Hospital, Shizuoka, Japan
- 9Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
- 10Hyogo College of Medicine, Nishinomiya, Japan
- 11Kyoto University Hospital, Kyoto, Japan
Several studies suggested that prolonged dual antiplatelet therapy (DAPT) reduced the risks of ischemic events, but increased the risk of bleeding. Optimal duration of DAPT after left main coronary artery (LMCA) stenting remains unclear.
From Nov. 2004 to Dec. 2012, we enrolled consecutive 1809 patients who underwent LMCA stenting in 6 Japanese centers. We compared 5-year clinical outcomes after LMCA stenting between patients with and without DAPT at 1 year.
Mean follow-up period was 44 ± 27 months. A total of 1219 patients survived neither with any bleeding events nor with any coronary revascularization at 1 year (on-DAPT at 1 year: N=1092 [89.6%], off-DAPT at 1 year: N=123 [10.1%], and DAPT status unknown: N=4 [0.3%]). The cumulative 5-year incidence of myocardial infarction (2.5% vs 3.2%, p=0.87; adjusted HR 1.75 [95% CI. 0.43-12.1], p=0.47) and major bleeding events (7.7% vs 7.0%, p=0.64; adjusted HR 1.09 [95% CI. 0.53-2.60], p=0.82) were similar between patients with and without DAPT, respectively. Very late stent thrombosis (VLST, >1 year) occurred in only one patient in the off-DAPT group. While VLST in the LMCA lesion might lead a catastrophic outcome, the adjusted 5-year risks of all-cause death (17.9% vs 25.0%, p=0.22; adjusted HR 0.70 [95% CI. 0.45-1.11], p=0.12) and cardiac death (6.0% vs 5.9%, p=0.62; adjusted HR 0.97 [95% CI. 0.41-2.75], p=0.96) were also similar between the two groups. The cumulative 5-year incidence of target lesion revascularization was significantly higher in patients in the on-DAPT group than in the off-DAPT group (8.1% vs 2.5%; p=0.02; adjusted HR 4.07 [95%CI 1.21-25.3], p=0.02).
In the real-world clinical practice, 90% of patients continued to receive DAPT beyond 1 year after the LMCA stenting. Given that there were no significant differences in the ischemic and bleeding outcomes between patients with and without DAPT at 1 year, patients safely stop DAPT within 1 year after LMCA stenting.
CORONARY: PCI Outcomes