Author + information
- Received May 3, 2019
- Revision received July 31, 2019
- Accepted August 6, 2019
- Published online December 2, 2019.
- Sungsoo Cho, MD, PhDa,∗,
- Yong-Joon Lee, MDb,∗,
- Young-Guk Ko, MD, PhDb,∗ (, )
- Tae Soo Kang, MD, PhDa,∗∗ (, )
- Seong-Hoon Lim, MD, PhDa,
- Sung-Jin Hong, MDb,
- Chul-Min Ahn, MD, PhDb,
- Jung-Sun Kim, MD, PhDb,
- Byeong-Keuk Kim, MD, PhDb,
- Donghoon Choi, MD, PhDb,
- Myeong-Ki Hong, MD, PhDb and
- Yangsoo Jang, MD, PhDb
- aDivision of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan-si, Choongcheongnam-do, Korea
- bDivision of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- ↵∗Address for correspondence:
Dr. Young-Guk Ko, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
- ↵∗∗Division of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheon-si, Chunhcheongnam-do 31116, Korea.
Objectives The aim of this study was to investigate the optimal strategy for antiplatelet therapy in patients with lower extremity peripheral artery disease (PAD) after endovascular revascularization.
Background The optimal strategy for antiplatelet therapy in patients with PAD after endovascular revascularization has not been established.
Methods From March 2008 to February 2013, 693 patients with lower extremity PAD treated with different antiplatelet therapies, such as mono-antiplatelet therapy (MAPT) and dual-antiplatelet therapy (DAPT), of various durations after endovascular revascularization were analyzed. They were classified into 2 groups (DAPT <6 months or MAPT vs. DAPT ≥6 months). The primary outcomes were major adverse cardiovascular events and major adverse limb events. The safety outcome was major bleeding.
Results During 5-year follow-up, major adverse cardiovascular events occurred less frequently in the DAPT ≥6-month group than the DAPT <6-month or MAPT group (17.3% vs. 31.3%; hazard ratio: 0.44; 95% confidence interval: 0.30 to 0.65; p < 0.001). Major adverse limb events also occurred less frequently in the DAPT ≥6-month group than the DAPT <6-month or MAPT group (21.5% vs. 43.7%; hazard ratio: 0.42; 95% CI: 0.30 to 0.58; p < 0.001). However, major bleeding events were infrequent, with no signal toward harm with DAPT ≥6 months. Results were consistent after inverse probability-weighted adjustment and propensity score matching.
Conclusions Following endovascular revascularization for lower extremity PAD, DAPT ≥6 months was associated with decreased 5-year major adverse cardiovascular events and major adverse limb events.
↵∗ Drs. Cho and Lee contributed equally to this work.
This study was supported by grants from the Korea Healthcare Technology Research & Development Project, Ministry for Health & Welfare, Republic of Korea (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 (2015R1A2A2A01002731), and the Cardiovascular Research Center. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 3, 2019.
- Revision received July 31, 2019.
- Accepted August 6, 2019.
- 2019 American College of Cardiology Foundation
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