Effects of Prolonged Dual Antiplatelet Therapy in ST-Segment Elevation vs. Non-ST-Segment Elevation Myocardial Infarction
- Authors
- Kim, Jihoon; Song, Young Bin; Oh, Ju-Hyeon; Cho, Deok-Kyu; Lee, Jin Bae; Kim, Sang-Hyun; Jeong, Jin-Ok; Bae, Jang-Ho; Kim, Byung Ok; Cho, Jang Hyun; Suh, Il-Woo; Kim, Doo-il; Park, Hoon-Ki; Park, Jong-Seon; Choi, Woong Gil; Lee, Wang Soo; Choi, Ki Hong; Park, Taek Kyu; Lee, Joo Myung; Yang, Jeong Hoon; Choi, Jin-Ho; Choi, Seung-Hyuk; Gwon, Hyeon-Cheol; Doh, Joon-Hyung; Hahn, Joo-Yong
- Issue Date
- Jun-2021
- Publisher
- JAPANESE CIRCULATION SOC
- Keywords
- Dual antiplatelet therapy; Myocardial infarction; Outcomes
- Citation
- CIRCULATION JOURNAL, v.85, no.6, pp 817 - +
- Journal Title
- CIRCULATION JOURNAL
- Volume
- 85
- Number
- 6
- Start Page
- 817
- End Page
- +
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/50821
- DOI
- 10.1253/circj.CJ-20-0704
- ISSN
- 1346-9843
1347-4820
- Abstract
- Background: The benefits and risks of prolonged dual antiplatelet therapy (DAPT) have not been studied extensively across a broad spectrum of acute coronary syndromes. In this study we investigated whether treatment effects of prolonged DAPT were consistent in patients presenting with ST-segment elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI). Methods and Results: As a post hoc analysis of the SMART-DATE trial, effects of >= 12 vs. 6 months DAPT were compared among 1,023 patients presenting with STEMI and 853 NSTEMI patients. The primary outcome was a composite of recurrent myocardial infarction (MI) or stent thrombosis at 18 months after the index procedure. Compared with the 6-month DAPT group, the rate of the composite endpoint was significantly lower in the >= 12-month DAPT group (1.2% vs. 3.8%; hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.12-0.77; P=0.012). The treatment effect of >= 12- vs. 6-month DAPT on the composite endpoint was consistent among NSTEMI patients (0.2% vs. 1.2%, respectively; HR 0.20, 95% CI 0.02-1.70; P=0.140; P-interaction=0.718). In addition, >= 12-month DAPT increased Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding among both STEMI (4.4% vs. 2.0%; HR 2.18, 95% CI 1.03-4.60; P=0.041) and NSTEMI (5.1% vs. 2.2%; HR 2.37, 95% CI 1.08-5.17; P=0.031; P-interaction=0.885) patients. Conclusions: Compared with 6-month DAPT, >= 12-month DAPT reduced recurrent MI or stent thrombosis regardless of the type of MI at presentation.
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