title: Dual antiplatelet therapy in patients with a long coronary artery lesion over 30 mm: Determinants and impact on prognosis.
abstract: BACKGROUND
  The ideal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is under debate. Lesion length is a well-recognized predictor of PCI complexity and long-term outcome.
  
  
  OBJECTIVE
  To evaluate the determinants and impact on outcome of long-term DAPT in a retrospective cohort of patients treated for a long coronary lesion.
  
  
  METHODS
  Patients (n=460) who underwent PCI for a long lesion (>30 mm) were divided into two groups according to antiplatelet regimen at 1 year: patients who stopped DAPT before 1 year (single antiplatelet therapy group; n=168) and patients who continued DAPT for longer than 1 year (n=292).
  
  
  RESULTS
  Mean lesion length was 35.7±7.1 mm. The proportion of patients who continued DAPT after 1 year was 63.5%. The main determinants of long-term DAPT were initial presentation as myocardial infarction and implantation of a drug-eluting stent. Median follow-up was 37.4 (23-51) months after the 1-year period following the index PCI. Long-term DAPT was highly associated with a lower risk of all-cause and cardiovascular mortality by multivariable analysis and after adjustment for other predictors: hazard ratios 0.11 (95% confidence interval 0.03-0.32) and 0.15 (95% confidence interval 0.04-0.62), respectively. No increase in major bleeding was noted.
  
  
  CONCLUSIONS
  In a contemporary practice, nearly two-thirds of patients who undergo PCI for a long lesion are treated with DAPT for several years. Our results suggest that long-term DAPT is beneficial in this subset of patients identified as being at high risk.
authors: Hôpital Cardiologique, CHRU de Lille, Lille, France; Centre hospitalier de Valenciennes, Valenciennes, France.
authors: Aurélie
authors: A
authors: Manchuelle
authors: Hôpital Cardiologique, CHRU de Lille, Lille, France.
authors: Cédric
authors: C
authors: Delhaye
authors: Hôpital Cardiologique, CHRU de Lille, Lille, France; Faculté de médecine de Lille, Lille, France.
authors: Guillaume
authors: G
authors: Schurtz
authors: Hôpital Cardiologique, CHRU de Lille, Lille, France.
authors: Arnaud
authors: A
authors: Sudre
authors: Hôpital Cardiologique, CHRU de Lille, Lille, France; Faculté de médecine de Lille, Lille, France.
authors: Christopher
authors: C
authors: Hurt
authors: Service de cardiologie, hôpital Nord de Marseille, AP-HM, Marseille, France.
authors: Laurent
authors: L
authors: Bonello
authors: Service de cardiologie, hôpital Européen Georges-Pompidou, AP-HP, Paris, France.
authors: Etienne
authors: E
authors: Puymirat
authors: Hôpital Cardiologique, CHRU de Lille, Lille, France; Faculté de médecine de Lille, Lille, France; Inserm UMR744, Institut Pasteur de Lille, Lille, France.
authors: Christophe
authors: C
authors: Bauters
authors: Hôpital Cardiologique, CHRU de Lille, Lille, France; Faculté de médecine de Lille, Lille, France; Inserm UMR744, Institut Pasteur de Lille, Lille, France. Electronic address: gilles_lemesle@yahoo.fr.
authors: Gilles
authors: G
authors: Lemesle
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004334:Drug Administration Schedule; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Angioplastie coronaire percutanée; Anti-agrégant plaquettaire; Antiplatelet therapy; Arrêt du clopidogrel; Clopidogrel discontinuation; Double anti-agrégation plaquettaire; Drug-eluting stent; Dual antiplatelet therapy; Percutaneous coronary intervention; Stent actif