Objectives Twelve-month dual antiplatelet therapy (DAT) with aspirin and clopidogrel after drug-eluting stent (DES) implantation is routinely recommended. It is unclear if prolonged (> 12-month) DAT is also favourable, especially in high stent thrombosis subgroup such as true bifurcation lesion treated with two-stents strategy.
Methods From March 2009 to August 2010, all consecutive patients with successful PCI who received two-stents strategy for true bifurcation lesion and were treated with dual antiplatelet therapy (Clopidogrel plus Aspirin) were included in this retrospective study. All patients were followed up for more than 24 months (mean = 32.68 + /- 8.41 months). Major cardiovascular events, stent thrombosis and bleeding events were recorded.
Results Seventy eight patients were included and two-stent strategy included Crush technique (n = 42), Culotte technique (n = 20), T-stent technique (n = 10) and V-stent technique (n = 6). All patients were divided into two group according to the duration of DAT: 12-month DAT group (n = 40) and prolonged DAT group (n = 38). The clinical and procedural variables were compared between the two groups. The duration of 10 patients were less than 12 months, and the median DAT duration was 16.8 vs. 9.2 months for the prolonged DAT and 12-month group. At follow-up prolonged DAT duration did not reduce MACE rate included all-cause death, TLR and myocardial infarction compared with 12-month group (18.4% vs 20%, p = 0.6), and the incidence of stent thrombosis had no significant differences between two groups (5% vs 5.2% p = 0.8). Conversely, prolonged DAT duration clearly increased the risk of TIMI major bleeding (7.9% vs 2.5% p = 0.005).
Conclusions Prolonged DAT duration of true bifurcation coronary artery lesion treated with two-stents strategy may increase the risk of bleeding without reducing adverse events. These results needed to be verified by larger and randomised trials.