Impact of dual antiplatelet therapy duration on long-term outcomes following chronic total occlusion percutaneous coronary intervention.

Abstract

Background: Optimal dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention for coronary chronic total occlusion remains unclear. Thus, we aim to determine the optimal DAPT duration in this high-risk cohort with complex anatomy and procedures.

Methods: Between January 2010 and December 2013, 2659 consecutive chronic total occlusion patients undergoing percutaneous coronary intervention at Fu Wai Hospital were enrolled, and those without adverse events within 12 months were categorized into long (>12 months) or short-term (≤12 months) groups according to DAPT duration. The primary endpoint was a composite of cardiac death and spontaneous myocardial infarction at 5 years. The safety endpoint was the rate of Bleeding Academic Research Consortium (BARC) 2, 3 or 5 type bleeding at 5 years.

Results: Overall, 1923 patients were included in the final analysis, of which 1104 (57.4%) continued DAPT beyond 12 months. Compared with short-term DAPT, long-term DAPT was associated with a lower rate of primary outcome (3.6% vs. 6.3%; adjusted hazard ratio[aHR]: 0.58 [95% CI, 0.38 to 0.89], p=0.01), primarily driven by fewer cardiac death (0.1% vs. 4.0%, aHR:0.02 [95% CI, 0.00 to 0.17]; p<0.001); and a higher risk of BARC 2-5 bleeding (3.8% vs. 1.5%; aHR: 2.61 [95% CI, 1.37 to 4.97], p<0.01), whereas the risk of BARC 3 or greater was comparable between groups.

Conclusion: In patients undergoing chronic total occlusion percutaneous coronary intervention, prolonged DAPT was associated with a reduced risk of cardiac death and myocardial infarction, but with an increased risk of minor bleeding.