Author + information
- Received September 11, 2017
- Revision received October 9, 2017
- Accepted October 11, 2017
- Published online March 5, 2018.
- Seung-Yul Lee, MDa,
- Myeong-Ki Hong, MD, PhDb,c,d,∗ (, )
- Tullio Palmerini, MDe,
- Hyo-Soo Kim, MDf,
- Marco Valgimigli, MDg,
- Fausto Feres, MDh,
- Antonio Colombo, MDi,
- Martine Gilard, MDj,
- Dong-Ho Shin, MDb,c,
- Jung-Sun Kim, MDb,c,
- Byeong-Keuk Kim, MDb,c,
- Young-Guk Ko, MDb,c,
- Donghoon Choi, MDb,c,
- Yangsoo Jang, MDb,c,d and
- Gregg W. Stone, MDk
- aSanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
- bSeverance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- cCardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- dSeverance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
- eDipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
- fDepartment of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- gDepartment of Cardiology, Bern University Hospital, University of Bern, Switzerland
- hInstituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
- iInterventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- jDepartment of Cardiology, CHU de la Cavale Blanche, Brest, France
- kColumbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
- ↵∗Address for correspondence:
Dr. Myeong-Ki Hong, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
Objectives This study sought to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent (DES) in elderly patients.
Background Qualified studies to evaluate the optimal duration of DAPT in elderly patients have been very limited.
Methods Using 6 randomized trials that compared short-term (≤6 months) and long-term (12 months) DAPT, individual participant data meta-analysis was performed in elderly patients (≥65 years of age). The primary study outcome was the 12-month risk of a composite of myocardial infarction, definite or probable stent thrombosis, or stroke. The major secondary outcome was the 12-month risk of major bleeding.
Results The primary outcome risk did not significantly differ between patients receiving short-term and long-term DAPT (hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.88 to 1.43; p = 0.3581) in the overall group of study participants. In subgroup analysis, a significant interaction between age and DAPT duration was observed for primary outcome risk (p for interaction = 0.0384). In the subset of younger patients (<65 years of age, n = 6,152), short-term DAPT was associated with higher risk of primary outcome (HR: 1.67; 95% CI: 1.14 to 2.44; p = 0.0082). In elderly patients (n = 5,319), however, the risk of primary outcome did not significantly differ between patients receiving short-term and long-term DAPT (HR: 0.84; 95% CI: 0.60 to 1.16; p = 0.2856). Short-term DAPT was associated with a significant reduction in major bleeding compared with long-term DAPT (HR: 0.50; 95% CI: 0.30 to 0.84; p = 0.0081) in the overall group, and particularly in elderly patients (HR: 0.46; 95% CI: 0.24-0.88; p = 0.0196).
Conclusions Short-term DAPT after new-generation DES implantation may be more beneficial in elderly patients than in younger patients.
This study was supported by a grant from the Korea Healthcare Technology Research & Development Project, Ministry for Health & Welfare, Republic of Korea (Nos. A085136 and HI15C1277), the Mid-Career Researcher Program through an National Research Foundation grant funded by the Ministry of Education, Science, and Technology, Republic of Korea (No. 2015R1A2A2A01002731), and the Cardiovascular Research Center, Seoul, Korea. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 11, 2017.
- Revision received October 9, 2017.
- Accepted October 11, 2017.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.