Long-term DAPT reduces risk of cardiac death, myocardial infarction

Prolonged dual antiplatelet therapy (DAPT) duration appears to lower the risk of cardiac death and myocardial infarction, but may increase the risk of minor bleeding, in patients undergoing chronic total occlusion percutaneous coronary intervention, reports a recent study.

Of the 1,923 patients included in the final analysis, 1,104 (57.4 percent) continued DAPT beyond 12 months. Long-term DAPT, compared with short-term use, correlated with a lower rate of the composite of cardiac deaths and spontaneous myocardial infarction at 5 years (3.6 percent vs 6.3 percent; adjusted hazard ratio [aHR], 0.58, 95 percent confidence interval [CI], 0.38‒0.89; p=0.01).

This risk reduction was driven by fewer cardiac deaths (0.1 percent vs 4.0 percent; aHR, 0.02, 95 percent CI, 0.00‒0.17; p<0.001).

On the other hand, prolonged DAPT duration was associated with a higher risk of Bleeding Academic Research Consortium (BARC) 2‒5 bleeding (3.8 percent vs 1.5 percent; aHR, 2.61, 95 percent CI, 1.37‒4.97; p<0.01). The risk of BARC 3 or greater did not significantly differ between groups.

A total of 2,659 consecutive chronic total occlusion patients undergoing percutaneous coronary intervention at Fuwai Hospital were enrolled in this study between January 2010 and December 2013. Those without adverse events within 12 months were categorized into long-term (>12 months) or short-term (≤12 months) groups according to DAPT duration.

A composite of cardiac deaths and spontaneous myocardial infarction at 5 years served as the primary outcome. The safety endpoint was the rate of BARC 2, 3, or 5 type bleeding at 5 years.