Abstract 14690: The Impact of Long-Term Dual Antiplatelet Therapy in Patients Treated for Bifurcation Lesions with Sirolimus-Eluting Stent
Purpose: The optimal duration of dual antiplatelet therapy (DAPT: aspirin and thienopyridine) after drug-eluting stent implantation remains unclear, especially for high risk patients. As bifurcation lesions (BLs) and bifurcation stenting could be related to stent thrombosis (ST), we evaluated the impact of DAPT duration on ST in patients treated for BLs with sirolimus-eluting stent (SES).
Methods and Results: A total of 2494 patients received the first SES implantation from November 2002 to December 2007 in our hospital. Complete 3-year follow-up was achieved in 99.2% of the patients; median duration of follow-up was 1647 days (4.5 years) (interquartile range 1356-1944 days). Of all patients (1602 with non-BLs and 892 with BLs), 27 (12 and 15) had ST. Of the 892 patients treated for BLs, single stent implantation with Kissing-balloon technique (S-KBT) was used for 633 and 2-stent (culotte and T-stent) technique for 259 (85 and 174). Among 892 patients with BLs, 244 S-KBT, 21 culotte, and 71 T-stent patients had DAPT discontinuation after stent implantation. Among patients treated by 2-stent technique, 8 patients had ST; 7 of them under non-DAPT and all of 5 patients with very late (more than 1 year) ST not only under non-DAPT but also with T-stent technique. The cumulative incidence of ST which might relate to S-KBT or 2-stent technique was evaluated by the Kaplan-Meier method (S-KBT vs. 2-stent technique; Log-rank p=0.046) and 1-year landmark analysis of 2-stent patients (non-DAPT and T-stent technique vs. others; Log-rank p=0.019). Results are shown in the figures.
Conclusion: Long-term DAPT could be recommended in patients treated with T-stent technique for BLs.
- © 2011 by American Heart Association, Inc.