title: Impact of six versus 12 months of dual antiplatelet therapy in patients with drug-eluting stent implantation after risk stratification with the residual SYNTAX score: Results from a secondary analysis of the I-LOVE-IT 2 trial.
abstract: BACKGROUND
  The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation remains undetermined, especially for those at high risk of cardiac events postprocedure.
  
  
  OBJECTIVE
  This study was aimed to investigate the impact of 6 versus 12 months of DAPT after DES implantation based on risk stratification with the residual SYNTAX score (rSS).
  
  
  METHODS
  A total of 2737 patients in the I-LOVE-IT 2 trial were grouped according to rSS status (low rSS [rSS = 0, n = 1474] versus high rSS [rSS > 0, n = 1263]) and DAPT duration (6 months vs. 12 months). The primary endpoint was 12-month target lesion failure (TLF), and the major secondary endpoints were 12-month net adverse clinical events (NACE) and major bleeding.
  
  
  RESULTS
  Incidences of TLF (5.2 vs. 7.4%, P = 0.01) and NACE (9.2 vs. 13.4%, P < 0.001) at 12 months were significantly higher in patients with high rSSs compared with patients with low rSSs. Landmark analysis showed that, in patients with high rSS, 12-month DAPT was associated with slightly lower risks of TLF (3.0% vs. 1.6%, P = 0.08) and NACE (7.0 vs. 4.4%, P = 0.054) compared with 6-month DAPT within 6 to 12 months after PCI. Patients with different DAPT durations had similar risks of bleeding both in the low and high rSS groups.
  
  
  CONCLUSIONS
  Patients with high rSSs have an increased risk of TLF and NACE at 12 months after DES implantation. Twelve-month DAPT might be superior to 6-month DAPT in patients with high rSS for reducing adverse events within 6 to 12 months after PCI without excessive risk of bleeding. © 2017 Wiley Periodicals, Inc.
authors.affiliation: The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China.|The Graduate School of Dalian Medical University, Dalian, China.
authors.forename: Miaohan
authors.initials: M
authors.lastname: Qiu
authors.affiliation: The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Xu
authors.affiliation: The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China.
authors.forename: Quanmin
authors.initials: Q
authors.lastname: Jing
authors.affiliation: The Department of Cardiology, Shenzhen People's Hospital, Shenzhen, China.
authors.forename: Shaohong
authors.initials: S
authors.lastname: Dong
authors.affiliation: The Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Jin
authors.affiliation: The Department of Cardiology, Yidu Central Hospital of Weifang City, China.
authors.forename: Pitian
authors.initials: P
authors.lastname: Zhao
authors.affiliation: The Catheterization Laboratory, Fu Wai Hospital, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China.
authors.forename: Yaling
authors.initials: Y
authors.lastname: Han
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002681:China; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus
keywords: drug-eluting stents; dual antiplatelet therapy; residual SYNTAX score