Prolonging dual antiplatelet therapy improves the long-term prognosis in patients with diabetes mellitus undergoing complex percutaneous coronary intervention

Jing-Jing Xu; Si-Da Jia; Pei Zhu; Ying Song; De-Shan Yuan; Xue-Yan Zhao; Yi Yao; Lin Jiang; Jian-Xin Li; Yin Zhang; Lei Song; Run-Lin Gao; Ya-Ling Han; Jin-Qing Yuan

doi:10.26599/1671-5411.2023.08.004

Prolonging dual antiplatelet therapy improves the long-term prognosis in patients with diabetes mellitus undergoing complex percutaneous coronary intervention

J Geriatr Cardiol. 2023 Aug 28;20(8):586-595. doi: 10.26599/1671-5411.2023.08.004.

Authors

Jing-Jing Xu¹, Si-Da Jia¹, Pei Zhu¹, Ying Song¹, De-Shan Yuan¹, Xue-Yan Zhao¹, Yi Yao¹, Lin Jiang¹, Jian-Xin Li¹, Yin Zhang¹, Lei Song¹, Run-Lin Gao¹, Ya-Ling Han², Jin-Qing Yuan¹

Affiliations

¹ Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.

Abstract

Objective: To investigate the optimal duration of dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) requiring complex percutaneous coronary intervention (PCI).

Methods: A total of 2403 patients with DM who underwent complex PCI from January to December 2013 were consecutively enrolled in this observational cohort study and divided according to DAPT duration into a standard group (11-13 months, n = 689) and two prolonged groups (13-24 months, n = 1133; > 24 months, n = 581).

Results: Baseline characteristics, angiographic findings, and complexity of PCI were comparable regardless of DAPT duration. The incidence of major adverse cardiac and cerebrovascular event was lower when DAPT was 13-24 months than when it was 11-13 months or > 24 months (4.6% vs. 8.1% vs. 6.0%, P = 0.008), as was the incidence of all-cause death (1.9% vs. 4.6% vs. 2.2%, P = 0.002) and cardiac death (1.0% vs. 3.0% vs. 1.2%, P = 0.002). After adjustment for confounders, DAPT for 13-24 months was associated with a lower risk of major adverse cardiac and cerebrovascular event [hazard ratio (HR) = 0.544, 95% CI: 0.373-0.795] and all-cause death (HR = 0.605, 95% CI: 0.387-0.944). DAPT for > 24 months was associated with a lower risk of all-cause death (HR = 0.681, 95% CI: 0.493-0.942) and cardiac death (HR = 0.620, 95% CI: 0.403-0.952). The risk of major bleeding was not increased by prolonging DAPT to 13-24 months (HR = 1.356, 95% CI: 0.766-2.401) or > 24 months (HR = 0.967, 95% CI: 0.682-1.371).

Conclusions: For patients with DM undergoing complex PCI, prolonging DAPT might improve the long-term prognosis by reducing the risk of adverse ischemic events without increasing the bleeding risk.