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Dual Antiplatelet Therapy for More Than 12 Months after Percutaneous Coronary Intervention: Insights from the Guthrie PCI Registry
  1. Kishore J Harjai (kharjai{at}aol.com)
  1. Guthrie Clinic, United States
    1. Chetan Shenoy
    1. Duke University Medical Center, United States
      1. Pamela Orshaw
      1. Guthrie Clinic, United States
        1. Judy Boura
        1. William Beaumont Hospital, United States

          Abstract

          Objective: Assess the impact of dual antiplatelet (DAP) therapy >12 months on long-term death and myocardial infarction (MI) after percutaneous coronary intervention (PCI).

          Design, setting and patients: Prospective, single centre, observational study of 1859 consecutive patients who underwent successful PCI of a native coronary artery and survived event-free for at least 12 months.

          Main outcome measures: Combined end-point of death or non-fatal MI determined by survival analysis and propensity-adjusted multivariable Cox regression. Similar analyses were performed in the 2 stent subsets: bare-metal stents (n=835), drug-eluting stents (n=1024); and 3 high-risk subsets: diabetics (n=486), patients presenting with MI (n=713), and those with ACC/AHA type C lesions (n=717).

          Results: Baseline characteristics were as follows: mean age 64±12 years, male 69%, diabetic 26%, presentation with MI 38%, ejection fraction 49±12%, mean vessel diameter 3.1±0.5 mm. Duration of DAP was 27±11 months in "DAP >12 months"; and 4.1±4.1 months in "DAP ≤12 months"; (p<0.0001). At a median follow-up of 3.4 years after PCI, "DAP >12 months"; Vs. "DAP ≤12 months"; had similar incidence of death or MI (9.4% Vs. 10%, log rank p=0.83). After multivariable adjustment, DAP therapy >12 months was not associated with lower incidence of death or MI than DAP therapy ≤12 months (adjusted HR=1.01; CI 0.74-1.37, p=0.95). Analysis of each of the 5 pre-defined subsets revealed similar results.

          Conclusions: In patients who undergo successful native coronary PCI and survive event-free for at least 12 months, continuation of dual anti-platelet therapy beyond 12-months does not confer long-term protection from death or MI.

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