Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Cardiovasc Interv Ther. 2022 Jan;37(1):101-108. doi: 10.1007/s12928-021-00765-8. Epub 2021 Feb 26.
Guidelines recommend shorter duration (1-12 months) for dual antiplatelet therapy (DAPT) in the second-generation drug-eluting stent (DES) era. However, whether shorter DAPT duration affects stent strut conditions and neointimal characteristics at mid-term follow-up remains uncertain. Therefore, we studied the relation between DAPT duration and vascular healing response as assessed by optical coherence tomography (OCT). This study was retrospective observational study. Participants comprised 64 patients who underwent serial OCT at both 9 and 18 months after DES implantation. All patients received DAPT until the 9-month follow-up then were divided into two groups: 49 patients who continued DAPT (longer DAPT group); and 15 patients who stopped taking the P2Y12 inhibitor and were treated with aspirin alone (shorter DAPT group) at the 18-month follow-up. Using OCT, we evaluated and compared stent strut conditions and neointimal characteristics between groups at both 9 and 18 months after stent implantation. Baseline clinical and procedural parameters were mostly similar between groups. At the 18-month follow-up, no in-stent thrombus assessed by OCT was observed in either group. No significant differences in OCT characteristics or measurements of neointima were seen between groups at 9- or 18-month follow-ups. Neointimal volume increased from 9 to 18 months in both groups, with a similar degree of neointimal proliferation in both groups (shorter DAPT group, 0.23 ± 0.29 mm/mm; longer DAPT group, 0.19 ± 0.27 mm/mm; P = 0.56). In conclusion, interrupting DAPT 9 months after second-generation DES implantation did not affect the development of in-stent thrombus, neointimal proliferation or stent strut coverage at 18-month follow-up compared with continuing DAPT.
指南建议在第二代药物洗脱支架（DES）时代将双联抗血小板治疗（DAPT）的持续时间缩短（1-12 个月）。然而，DAPT 持续时间较短是否会影响中期随访时的支架梁状况和新生内膜特征仍不确定。因此，我们通过光学相干断层扫描（OCT）研究了 DAPT 持续时间与血管愈合反应之间的关系。本研究为回顾性观察性研究。参与者包括 64 名患者，他们在 DES 植入后 9 个月和 18 个月时分别进行了连续 OCT 检查。所有患者均接受 DAPT 治疗，直至 9 个月随访，然后分为两组：49 名继续 DAPT（DAPT 持续时间较长组）；和 15 名在 18 个月随访时停止服用 P2Y12 抑制剂并单独服用阿司匹林的患者（DAPT 持续时间较短组）。通过 OCT，我们评估并比较了两组患者在支架植入后 9 个月和 18 个月时的支架梁状况和新生内膜特征。两组患者的基线临床和手术参数大多相似。在 18 个月的随访中，两组均未观察到 OCT 评估的支架内血栓。两组在 9 个月或 18 个月的随访中，OCT 特征或新生内膜测量值均无显著差异。两组的新生内膜体积均从 9 个月增加到 18 个月，两组的新生内膜增殖程度相似（DAPT 持续时间较短组，0.23±0.29mm/mm；DAPT 持续时间较长组，0.19±0.27mm/mm；P=0.56）。总之，与继续 DAPT 相比，在第二代 DES 植入后 9 个月中断 DAPT 不会影响 18 个月随访时支架内血栓形成、新生内膜增殖或支架梁覆盖率的发展。
