Giacoppo D, Baber U, Mehran R
Cardiology Department, Mount Sinai Hospital, New York, NY, USA -
Minerva Cardioangiol. 2014 Jun;62(3):261-76.
Dual antiplatelet therapy (DAPT) with acetylsalicylic acid and an inhibitor of the adenosine diphosphate platelet receptor P2Y12 has been shown to reduce the risk of stent thrombosis (ST), myocardial infarction and cardiac death after percutaneous coronary intervention (PCI) with bare-metal stents (BMS) and drug-eluting stents (DES). However, while there is consensus on 1-month DAPT after BMS, the optimal duration and the risk-benefit ratio of DAPT duration after DES implantation remains controversial. Controversy surrounding this issue is demonstrated by differences in guideline recommendations for DAPT duration after PCI with DES. For example, while the ACC/AHA recommends a minimum of 12 months, ESC guidelines recommend at least 6 months of DAPT. Recent reports suggest that 6 months of DAPT after second-generation DES implantation might be safe compared with longer durations. Large randomized controlled trials powered to examine ST and bleeding events are currently ongoing and will shed novel insight on unresolved concerns and inform medical practice in the foreseeable future. In the present review, we critically and comprehensively examine the current level of evidence regarding the optimal duration of DAPT after PCI with DES and illustrate new and future perspectives surrounding this rapidly changing field.
已证实，使用乙酰水杨酸和二磷酸腺苷血小板受体P2Y12抑制剂进行双重抗血小板治疗（DAPT）可降低裸金属支架（BMS）和药物洗脱支架（DES）经皮冠状动脉介入治疗（PCI）后发生支架血栓形成（ST）、心肌梗死和心源性死亡的风险。然而，虽然对于BMS植入后1个月的DAPT已达成共识，但DES植入后DAPT的最佳持续时间及其风险效益比仍存在争议。PCI术后使用DES进行DAPT持续时间的指南建议存在差异，这表明了围绕该问题的争议。例如，虽然美国心脏病学会/美国心脏协会（ACC/AHA）建议至少12个月，但欧洲心脏病学会（ESC）指南建议至少6个月的DAPT。最近的报告表明，与更长时间相比，第二代DES植入后6个月的DAPT可能是安全的。目前正在进行大型随机对照试验，以研究ST和出血事件，这将为未解决的问题提供新的见解，并在可预见的未来为医疗实践提供参考。在本综述中，我们批判性地、全面地审视了目前关于DES PCI术后DAPT最佳持续时间的证据水平，并阐述了围绕这一快速变化领域的新观点和未来展望。
