Long-term DAPT better after left main coronary artery bifurcation stenting

Longer dual antiplatelet therapy (DAPT) durations after left main coronary artery (LMCA) bifurcation stenting lead to better clinical outcomes, reports a new study.

Accessing two multicentre registries, researchers enrolled 1,142 patients who were given a drug-eluting stent for an LMCA bifurcation lesion. Majority had taken DAPT for >12 months (n=769; mean age, 62.63±10.21 years; 74.3 percent male); the remaining 373 (mean age, 63.86±10.28 years; 75.3 percent male) had underwent shorter treatment duration of at most 12 months.

The primary study endpoint was the incidence of major adverse cardiovascular events, defined as a composite of cardiac death, stroke, stent thrombosis and myocardial infarction, over 5 years of follow-up.

The incidence rate of MACE in the prolonged DAPT group was 2.3 percent (n=18), while in the group that received the shorter course, it was 5.4 percent (n=20). This corresponded to a statistically significant difference in risk on Cox proportional hazards analysis after propensity score matching, in favour of the longer DAPT regimen (hazard ratio [HR], 0.25, 95 percent confidence interval [CI], 0.1–0.68; p=0.01).

Disaggregating according to the individual MACE components showed that a longer DAPT course likewise significantly reduced the risk of all-cause death (HR, 0.49, 95 percent CI, 0.24–1.0; p=0.05) and cardiac death (HR, 0.17, 95 percent CI, 0.04–0.79; p=0.02) in the matched cohort. No such effect was reported for myocardial infarction (HR, 0.39, 95 percent CI, 0.12–1.23; p=0.11) and stroke (HR, 0.5, 95 percent CI, 0.09–2.7; p=0.42).