Lee Seung-Jun, Choi Dong-Woo, Kim Choongki, Suh Yongsung, Hong Sung-Jin, Ahn Chul-Min, Kim Jung-Sun, Kim Byeong-Keuk, Ko Young-Guk, Choi Donghoon, Park Eun-Cheol, Jang Yangsoo, Nam Chung-Mo, Hong Myeong-Ki
Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Front Cardiovasc Med. 2022 Aug 11;9:954704. doi: 10.3389/fcvm.2022.954704. eCollection 2022.
Optimal duration of dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) who have undergone drug-eluting stent (DES) implantation is not clearly established. This study sought to impact of DAPT duration on real-world clinical outcome in patients with or without DM.
Using a nationwide cohort database, we investigate the association between DAPT duration and clinical outcome between 1 and 3 years after percutaneous coronary intervention (PCI). Primary outcome was all-cause death. Secondary outcomes were cardiovascular death, myocardial infarction, and composite bleeding events. After weighting, 90,100 DES-treated patients were included; 29,544 patients with DM and 60,556 without DM; 31,233 patients with standard DAPT (6-12 months) and 58,867 with prolonged DAPT (12-24 months).
The incidence of all-cause death was significantly lower in patients with prolonged DAPT [8.3% vs. 10.5% in those with standard DAPT, hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.72-0.84] in diabetic patients and non-diabetic patients (4.5% vs. 5.0% in those with standard DAPT, HR 0.89, 95% CI 0.83-0.96). The incidence of composite bleeding events was 5.7% vs. 5.4%, respectively, (HR 1.07, 95% CI 0.96-1.18) in diabetic patients and 5.6% vs. 5.0%, respectively, in non-diabetic patients (HR 1.13, 95% CI 1.05-1.21). There was a significant interaction between the presence of DM and DAPT duration for all-cause death (p for interaction, p = 0.01) that further favored prolonged DAPT in diabetic patients. However, there was no significant interaction between the presence of DM and DAPT duration for composite bleeding events (p = 0.38).
This study showed that prolonged rather than standard DAPT might be clinically beneficial in diabetic patients with DES implantation.
ClinicalTrial.gov (NCT04715594).
糖尿病（DM）患者植入药物洗脱支架（DES）后双联抗血小板治疗（DAPT）的最佳持续时间尚未明确确定。本研究旨在探讨DAPT持续时间对有或无DM患者实际临床结局的影响。
利用全国性队列数据库，我们调查了经皮冠状动脉介入治疗（PCI）后1至3年DAPT持续时间与临床结局之间的关联。主要结局是全因死亡。次要结局是心血管死亡、心肌梗死和复合出血事件。加权后，纳入了90100例接受DES治疗的患者；29544例DM患者和60556例非DM患者；31233例接受标准DAPT（6 - 12个月）的患者和58867例接受延长DAPT（12 - 24个月）的患者。
在糖尿病患者和非糖尿病患者中，延长DAPT组的全因死亡发生率均显著低于标准DAPT组（糖尿病患者中分别为8.3%和10.5%，风险比（HR）0.78，95%置信区间（CI）0.72 - 0.84；非糖尿病患者中分别为4.5%和5.0%，HR 0.89，95% CI 0.83 - 0.96）。糖尿病患者复合出血事件的发生率分别为5.7%和5.4%（HR 1.07，95% CI 0.96 - 1.18），非糖尿病患者分别为5.6%和5.0%（HR 1.13，95% CI 1.05 - 1.21）。在全因死亡方面，DM的存在与DAPT持续时间之间存在显著交互作用（交互作用p值，p = 0.01），这进一步表明延长DAPT对糖尿病患者更有利。然而，在复合出血事件方面，DM的存在与DAPT持续时间之间没有显著交互作用（p = 0.38）。
本研究表明，对于植入DES的糖尿病患者，延长而非标准DAPT可能在临床上有益。
ClinicalTrial.gov（NCT04715594）。
