Frontiers in Cardiovascular Medicine (Aug 2022)

Prolonged dual antiplatelet therapy after drug-eluting stent implantation in patients with diabetes mellitus: A nationwide retrospective cohort study

  • Seung-Jun Lee,
  • Dong-Woo Choi,
  • Dong-Woo Choi,
  • Choongki Kim,
  • Yongsung Suh,
  • Sung-Jin Hong,
  • Chul-Min Ahn,
  • Jung-Sun Kim,
  • Byeong-Keuk Kim,
  • Young-Guk Ko,
  • Donghoon Choi,
  • Eun-Cheol Park,
  • Yangsoo Jang,
  • Chung-Mo Nam,
  • Myeong-Ki Hong

DOI
https://doi.org/10.3389/fcvm.2022.954704
Journal volume & issue
Vol. 9

Abstract

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BackgroundOptimal duration of dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) who have undergone drug-eluting stent (DES) implantation is not clearly established. This study sought to impact of DAPT duration on real-world clinical outcome in patients with or without DM.MethodsUsing a nationwide cohort database, we investigate the association between DAPT duration and clinical outcome between 1 and 3 years after percutaneous coronary intervention (PCI). Primary outcome was all-cause death. Secondary outcomes were cardiovascular death, myocardial infarction, and composite bleeding events. After weighting, 90,100 DES-treated patients were included; 29,544 patients with DM and 60,556 without DM; 31,233 patients with standard DAPT (6–12 months) and 58,867 with prolonged DAPT (12–24 months).ResultsThe incidence of all-cause death was significantly lower in patients with prolonged DAPT [8.3% vs. 10.5% in those with standard DAPT, hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.72–0.84] in diabetic patients and non-diabetic patients (4.5% vs. 5.0% in those with standard DAPT, HR 0.89, 95% CI 0.83–0.96). The incidence of composite bleeding events was 5.7% vs. 5.4%, respectively, (HR 1.07, 95% CI 0.96–1.18) in diabetic patients and 5.6% vs. 5.0%, respectively, in non-diabetic patients (HR 1.13, 95% CI 1.05–1.21). There was a significant interaction between the presence of DM and DAPT duration for all-cause death (p for interaction, pint = 0.01) that further favored prolonged DAPT in diabetic patients. However, there was no significant interaction between the presence of DM and DAPT duration for composite bleeding events (pint = 0.38).ConclusionsThis study showed that prolonged rather than standard DAPT might be clinically beneficial in diabetic patients with DES implantation.Trial registrationClinicalTrial.gov (NCT04715594).

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