Abstract 11433: Extension Of Dual Anti-Platelet Therapy Beyond 12 Months Did Not Affect the Frequency of MACE, but Increased Bleeding Complications
The optimal duration of DAPT (dual anti-platelet therapy of aspirin plus tienopyridine: DAPT) is still controversial. We assessed the hypothesis that extensive administration of tienopyridine beyond 12 months reduces major adverse cardiac events including stent thrombosis (a benefit) but increases bleeding complications (a risk) in the long term. The database of J-PMS (a prospective multicenter registry of post-marketing surveillance in Japan of sirolimus-eluting stent [SES]) was used. We divided the patients who completed their 5-year follow-up into 2 groups according to their DAPT duration. DAPT≤12Mo consisted of 749 patients and the remaining 942 patients belonged to DAPT>12Mo. Then, the incidence of MACE (death, MI, TLR), thrombosis and bleeding complications were compared by landmark analysis at 12 months. The number of patients was higher in DAPT<12Mo regarding history of receiving PCI (50.2% vs 58.4%, P<0.001), CABG (5.9% vs 9.1%, P=0.013) and hemodialysis (2.3% vs 5.2%, P=0.002), and frequency of multi vessel disease (35.8% vs 43.7%, P=0.001), in-stent restenosis (11.8% vs 15.0%, P=0.036) and small caliber stent (3.02±0.36 vs 2.98±0.36mm, P=0.006). There was no difference between the 2 groups in death (10.0% vs 11.5%), MI (2.3% vs 2.1%), and TLR (4.5% vs 6.3%). Landmark analysis using propensity score matching presented no difference in the incidence of MACE or thrombosis, but a steady increase in bleeding complications (figure). In conclusion, extension of DAPT beyond 12 months did not affect the frequency of major advance cardiac events, including VLST, but increased bleeding complications.
- © 2011 by American Heart Association, Inc.