TY - JOUR
T1 - Dual antiplatelet therapy for more than 12 months after percutaneous coronary intervention
T2 - Insights from the Guthrie PCI Registry
AU - Harjai, K. J.
AU - Shenoy, C.
AU - Orshaw, P.
AU - Boura, J.
PY - 2009/10/1
Y1 - 2009/10/1
N2 - Objective: To assess the impact of dual antiplatelet (DAP) therapy of >12 months on long-term death and myocardial infarction (MI) after percutaneous coronary intervention (PCI). Design, setting and patients: Prospective, singlecentre, observational study of 1859 consecutive patients who underwent successful PCI of a native coronary artery and survived event-free for at least 12 months. Main outcome measures: Combined end point of death or non-fatal MI determined by survival analysis and propensity-adjusted multivariable Cox regression. Similar analyses were performed in the two stent subsets: bare metal stents (n=835), drug-eluting stents (n=1024); and three high-risk subsets: diabetic patients (n=486), patients presenting with MI (n=713), and those with ACC/AHA type C lesions (n=717). Results: Baseline characteristics were as follows: mean (SD) age 64 (12) years, male 69%, diabetic 26%, presentation with MI 38%, mean (SD) ejection fraction 49 (12)%, mean (SD) vessel diameter 3.1 (0.5) mm. Duration of DAP was 27 (11) months in "DAP >12 months" and 4.1 (4.1) months in "DAP ≤12 months" (p<0.001). At a median follow-up of 3.4 years after PCI, "DAP > 12 months" vs "DAP ≤12 months" had similar incidence of death or MI (9.4% vs 10.3%, log-rank p=0.83). After multivariable adjustment, DAP therapy >12 months was not associated with lower incidence of death or MI than DAP therapy ≤12 months (adjusted HR=1.01; 95% CI 0.74 to 1.37, p=0.95). Analysis of each of the five predefined subsets showed similar results. Conclusions: In patients who undergo successful native coronary PCI and survive event-free for at least 12 months, continuation of dual antiplatelet therapy beyond 12 months does not confer long-term protection from death or MI.
AB - Objective: To assess the impact of dual antiplatelet (DAP) therapy of >12 months on long-term death and myocardial infarction (MI) after percutaneous coronary intervention (PCI). Design, setting and patients: Prospective, singlecentre, observational study of 1859 consecutive patients who underwent successful PCI of a native coronary artery and survived event-free for at least 12 months. Main outcome measures: Combined end point of death or non-fatal MI determined by survival analysis and propensity-adjusted multivariable Cox regression. Similar analyses were performed in the two stent subsets: bare metal stents (n=835), drug-eluting stents (n=1024); and three high-risk subsets: diabetic patients (n=486), patients presenting with MI (n=713), and those with ACC/AHA type C lesions (n=717). Results: Baseline characteristics were as follows: mean (SD) age 64 (12) years, male 69%, diabetic 26%, presentation with MI 38%, mean (SD) ejection fraction 49 (12)%, mean (SD) vessel diameter 3.1 (0.5) mm. Duration of DAP was 27 (11) months in "DAP >12 months" and 4.1 (4.1) months in "DAP ≤12 months" (p<0.001). At a median follow-up of 3.4 years after PCI, "DAP > 12 months" vs "DAP ≤12 months" had similar incidence of death or MI (9.4% vs 10.3%, log-rank p=0.83). After multivariable adjustment, DAP therapy >12 months was not associated with lower incidence of death or MI than DAP therapy ≤12 months (adjusted HR=1.01; 95% CI 0.74 to 1.37, p=0.95). Analysis of each of the five predefined subsets showed similar results. Conclusions: In patients who undergo successful native coronary PCI and survive event-free for at least 12 months, continuation of dual antiplatelet therapy beyond 12 months does not confer long-term protection from death or MI.
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U2 - 10.1136/hrt.2009.169896
DO - 10.1136/hrt.2009.169896
M3 - Article
C2 - 19549619
AN - SCOPUS:70350020584
SN - 1355-6037
VL - 95
SP - 1579
EP - 1586
JO - Heart
JF - Heart
IS - 19
ER -