Dual Antiplatelet Therapy Duration After Multivessel Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention
Ko Yamamoto, Hiroki Shiomi, Takeshi Morimoto, Akiyoshi Miyazawa, Hiroki Watanabe, Sunao Nakamura, Satoru Suwa, Takenori Domei, Koh Ono, Hiroki Sakamoto, Masataka Shigetoshi, Ryoji Taniguchi, Hideki Okayama, Takafumi Yokomatsu, Masahiro Muto, Ren Kawaguchi, Koichi Kishi, Mitsuyoshi Hadase, Tsutomu Fujita, Yasunori Nishida, Masami Nishino, Hiromasa Otake, Masahiro Natsuaki, Hirotoshi Watanabe, Nobuhiro Suematsu, Kengo Tanabe, Mitsuru Abe, Kiyoshi Hibi, Kazushige Kadota, Kenji Andò, Takeshi Kimura, on behalf of the OPTIVUS-Complex PCI Investigators
Abstract
BACKGROUND: There is a scarcity of data evaluating contemporary real-world dual antiplatelet therapy (DAPT) strategies after percutaneous coronary intervention (PCI). METHODS AND RESULTS: inhibitors or aspirin for at least 2 months. The prevalence of acute coronary syndrome and high bleeding risk by the Bleeding Academic Research Consortium were 14.2% and 52.5%, respectively. The cumulative incidence of DAPT discontinuation was 22.6% at 90 days, and 68.8% at 1 year. In the 90-day landmark analyses, there were no differences in the incidences of a composite of death, myocardial infarction, stroke, or any coronary revascularization (5.9% vs. 9.2%, log-rank P=0.12; adjusted hazard ratio, 0.59; 95% confidence interval, 0.32-1.08; P=0.09) and BARC type 3 or 5 bleeding (1.4% vs. 1.9%, log-rank P=0.62) between the off- and on-DAPT groups at 90 days. CONCLUSIONS: The adoption of short DAPT duration was still low in this trial conducted after the release of the STOPDAPT-2 trial results. The 1-year incidence of cardiovascular events was not different between the shorter and longer DAPT groups, suggesting no apparent benefit of prolonged DAPT in reducing cardiovascular events even in patients who undergo multivessel PCI.