Oh Jun-Hyok, Kim Jinmi, Kim Jeong-Su, Lee Hye Won, Lee Sun Hack, Choe Jeong Cheon, Kim Min Sun, Ahn Jinhee, Choi Jung Hyun, Lee Han Cheol, Cha Kwang Soo
Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Pusan, Korea.
Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Pusan, Korea.
J Korean Med Sci. 2024 Dec 9;39(47):e294. doi: 10.3346/jkms.2024.39.e294.
The optimal duration and net clinical benefit of dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) have not been elucidated in real-world situations.
Using nationwide claims data from 2013 to 2021, we selected patients who underwent TAVR and categorized them into two groups: short- and long-term (≤ 3 and > 3 months, respectively) DAPT group. Propensity score matching was used to balance baseline characteristics. The primary endpoint was the occurrence of net adverse clinical events (NACEs), including all-cause death, myocardial infarction, stroke, any coronary and peripheral revascularization, systemic thromboembolism, and bleeding events, at 1 year. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards regression.
Patients who met the inclusion criteria (1,695) were selected. Propensity score matching yielded 1,215 pairs of patients: 416 and 799 in the short- and long-term DAPT groups, respectively. In the unmatched cohort, the mean ages were 79.8 ± 6.1 and 79.7 ± 5.8 years for the short- and long-term DAPT groups, respectively. In the matched cohort, the mean ages were 80.6 ± 5.9 and 79.9 ± 5.9 years for the short- and long-term DAPT groups, respectively. Over one year in the unmatched cohort, the NACE incidence was 11.9% and 11.5% in the short- and long-term DAPT groups, respectively ( = 0.893). The all-cause mortality rates were 7.4% and 4.7% ( = 0.042), composite ischemic event rates were 2.5% and 4.7% ( = 0.056), and bleeding event rates were 2.7% and 4.7% ( = 0.056) in the short- and long-term groups, respectively. In the matched cohort, the incidence of NACE was 9.6% in the short-term DAPT group and 11.6% in the long-term DAPT group, respectively ( = 0.329). The all-cause mortality rates were 6.5% and 4.9% ( = 0.298), composite ischemic event rates were 1.4% and 4.5% ( = 0.009), and bleeding event rates were 2.2% and 4.4% ( = 0.072) in the short- and long-term groups, respectively.
In patients who successfully underwent transfemoral TAVR, the short- and long-term DAPT groups exhibited similar one-year NACE rates. However, patients in the long-term DAPT group experienced more bleeding and ischemic events.
经导管主动脉瓣置换术（TAVR）后双重抗血小板治疗（DAPT）的最佳持续时间和净临床获益在现实世界中尚未明确。
利用2013年至2021年的全国索赔数据，我们选择了接受TAVR的患者，并将他们分为两组：短期和长期（分别≤3个月和>3个月）DAPT组。采用倾向评分匹配来平衡基线特征。主要终点是1年时净不良临床事件（NACE）的发生情况，包括全因死亡、心肌梗死、中风、任何冠状动脉和外周血管再血管化、系统性血栓栓塞和出血事件。使用Kaplan-Meier估计和Cox比例风险回归进行生存分析。
选择了符合纳入标准的患者（1695例）。倾向评分匹配产生了1215对患者：短期和长期DAPT组分别为416例和799例。在未匹配队列中，短期和长期DAPT组的平均年龄分别为79.8±6.1岁和79.7±5.8岁。在匹配队列中，短期和长期DAPT组的平均年龄分别为80.6±5.9岁和79.9±5.9岁。在未匹配队列中，一年以上时间里，短期和长期DAPT组的NACE发生率分别为11.9%和11.5%（P=0.893）。短期和长期组的全因死亡率分别为7.4%和4.7%（P=0.042），复合缺血事件发生率分别为2.5%和4.7%（P=0.056），出血事件发生率分别为2.7%和4.7%（P=0.056）。在匹配队列中，短期DAPT组的NACE发生率为9.6%，长期DAPT组为11.6%（P=0.329）。短期和长期组的全因死亡率分别为6.5%和4.9%（P=0.298），复合缺血事件发生率分别为1.4%和4.5%（P=0.009），出血事件发生率分别为2.2%和4.4%（P=0.072）。
在成功接受经股动脉TAVR的患者中，短期和长期DAPT组的1年NACE发生率相似。然而，长期DAPT组的患者经历了更多的出血和缺血事件。
