Yamamoto Ko, Shiomi Hiroki, Morimoto Takeshi, Miyazawa Akiyoshi, Watanabe Hiroki, Nakamura Sunao, Suwa Satoru, Domei Takenori, Ono Koh, Sakamoto Hiroki, Shigetoshi Masataka, Taniguchi Ryoji, Okayama Hideki, Yokomatsu Takafumi, Muto Masahiro, Kawaguchi Ren, Kishi Koichi, Hadase Mitsuyoshi, Fujita Tsutomu, Nishida Yasunori, Nishino Masami, Otake Hiromasa, Natsuaki Masahiro, Watanabe Hirotoshi, Suematsu Nobuhiro, Tanabe Kengo, Abe Mitsuru, Hibi Kiyoshi, Kadota Kazushige, Ando Kenji, Kimura Takeshi
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine.
Department of Clinical Epidemiology, Hyogo College of Medicine.
Circ J. 2023 Oct 25;87(11):1661-1671. doi: 10.1253/circj.CJ-23-0141. Epub 2023 May 16.
There is a scarcity of data evaluating contemporary real-world dual antiplatelet therapy (DAPT) strategies after percutaneous coronary intervention (PCI).
In the OPTIVUS-Complex PCI study multivessel cohort enrolling 982 patients undergoing multivessel PCI, including left anterior descending coronary artery using intravascular ultrasound (IVUS), we conducted 90-day landmark analyses to compare shorter and longer DAPT. DAPT discontinuation was defined as withdrawal of P2Yinhibitors 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.
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.
目前缺乏评估经皮冠状动脉介入治疗（PCI）后当代现实世界中双重抗血小板治疗（DAPT）策略的数据。
在OPTIVUS-复杂PCI研究的多支血管队列中，纳入了982例接受多支血管PCI的患者，包括使用血管内超声（IVUS）的左前降支冠状动脉，我们进行了90天的标志性分析，以比较较短和较长时间的DAPT。DAPT停药定义为停用P2Y抑制剂或阿司匹林至少2个月。急性冠状动脉综合征的患病率和出血学术研究联盟定义的高出血风险分别为14.2%和52.5%。DAPT停药的累积发生率在90天时为22.6%，1年时为68.8%。在90天的标志性分析中，90天时停药组和继续DAPT组在死亡、心肌梗死、中风或任何冠状动脉血运重建的复合发生率（5.9%对9.2%，对数秩检验P=0.12；调整后的风险比为0.59；95%置信区间为0.32-1.08；P=0.09）以及BARC 3型或5型出血发生率（1.4%对1.9%，对数秩检验P=0.62）方面没有差异。
在STOPDAPT-2试验结果发布后进行的这项试验中，采用短疗程DAPT的比例仍然较低。较短和较长DAPT组之间1年心血管事件发生率没有差异，这表明即使在接受多支血管PCI的患者中，延长DAPT时间在降低心血管事件方面没有明显益处。
