title: Clinical outcomes of dual antiplatelet therapy after implantation of drug-eluting stents in patients with different cardiovascular risk factors.
abstract: BACKGROUND
  The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been established yet. The objectives of this study were to evaluate the optimal duration of DAPT after the DES implantation.
  
  
  METHODS
  From three randomized controlled trials investigating DAPT duration after coronary stent implantation, we evaluated the clinical outcomes of short-term (6 months or less) DAPT compared with prolonged DAPT (12 months or more) in 1661 DES-treated pairs matched by propensity scores. At follow-up of 1 year, net adverse clinical event (NACE) was defined as cardiac death, myocardial infarction, target vessel revascularization, definite/probable stent thrombosis, or thrombolysis in myocardial infarction major bleeding.
  
  
  RESULTS
  Short-term DAPT as compared with prolonged DAPT was not associated with 1-year NACEs after DES implantation [hazard ratio (HR) 1.068, 95 % confidence interval (CI) 0.787-1.450, p = 0.671]. Predictors for NACEs were old age (>75 years), hypertension, diabetes mellitus, renal dysfunction (serum creatinine ≥2.0 mg/dL), and multi-vessel disease. The DAPT strategy differentially contributed to the occurrence of NACEs according to the risk burden (p for interaction <0.001). In patients with low risk for NACEs, bleeding events were less in short-term DAPT than in prolonged DAPT (HR 0.332, 95 % CI 0.130-0.849, p = 0.021) (p for interaction = 0.098). Meanwhile, short-term DAPT was associated with more ischemic events that included cardiac death, myocardial infarction, target vessel revascularization, or definite/probable stent thrombosis (HR 2.164, 95 % CI 1.340-3.494, p = 0.002) (p for interaction <0.001) in patients with high risk for NACEs.
  
  
  CONCLUSIONS
  One-year clinical outcomes of DAPT after DES implantation depended on the burden of cardiovascular risk.
authors.affiliation: Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea.
authors.forename: Seung-Yul
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Yonsei-ro 50-1, Seodaemun-Gu, Seoul, Korea. mkhong61@yuhs.ac.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea. mkhong61@yuhs.ac.|Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea. mkhong61@yuhs.ac.
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Yonsei-ro 50-1, Seodaemun-Gu, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Yonsei-ro 50-1, Seodaemun-Gu, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Yonsei-ro 50-1, Seodaemun-Gu, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Yonsei-ro 50-1, Seodaemun-Gu, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Yonsei-ro 50-1, Seodaemun-Gu, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Yonsei-ro 50-1, Seodaemun-Gu, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.|Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.affiliation: Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.affiliation: Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D020123:Sirolimus / Q000031:analogs & derivatives / Q000494:pharmacology; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; C489443:zotarolimus; D013988:Ticlopidine; D001241:Aspirin; D020123:Sirolimus
keywords: Antiplatelet therapy; Coronary artery disease; Drug-eluting stent