Abstract
Aims: It is currently unclear if the location of coronary artery disease affects decision making with regard to dual antiplatelet therapy (DAPT). We investigated if the presence of at least 30% luminal narrowing in the left main (LM) and/or proximal left anterior descending (pLAD) coronary arteries on angiography is an outcome modifier with respect to DAPT duration. Methods and results: In the Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia (PRODIGY) study, 953 (54.3%) patients with and 801 (45.7%) without LM/pLAD lumen narrowing at the qualifying coronary intervention were randomised to six or 24 months of DAPT. Twentyfour month as compared to six-month DAPT reduced the occurrence of definite, probable or possible stent thrombosis by 50% in patients with (2.8% vs. 5.6%; HR 0.45, 95% CI: 0.23-0.89; p=0.02) but not in those without LM/pLAD lumen narrowing, with a highly significant interaction testing (PINT = 0.002). This result remained consistent irrespective of whether stenting was (P: 0.01) or was not (PINT: 0.02) performed in the LM/pLAD. Conclusions: Left main and/or proximal LAD lumen narrowing may be a treatment modifier with respect to the duration of DAPT. Patients fulfilling these angiographic characteristics seem to benefit from a prolonged dual antiplatelet treatment. Trial registration: ClinicalTrials.gov Identifier: NCT00611286
| Original language | English |
|---|---|
| Pages (from-to) | e1222-e1230 |
| Journal | EuroIntervention |
| Volume | 11 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - Feb 1 2016 |
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Keywords
- Acute coronary syndrome
- Clopidogrel
- Dual antiplatelet therapy (DAPT)
- Left main coronary artery
- Proximal left anterior descending coronary artery
- Stent thrombosis
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Left main or proximal left anterior descending coronary artery disease location identifies high-risk patients deriving potentially greater benefit from prolonged dual antiplatelet therapy duration. / Costa, Francesco; Adamo, Marianna; Ariotti, Sara; Ferrante, Giuseppe; Navarese, Eliano Pio; Leonardi, Sergio; Garcia-Garcia, Hector; Vranckx, Pascal; Valgimigli, Marco.
In: EuroIntervention, Vol. 11, No. 11, 01.02.2016, p. e1222-e1230.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Left main or proximal left anterior descending coronary artery disease location identifies high-risk patients deriving potentially greater benefit from prolonged dual antiplatelet therapy duration
AU - Costa, Francesco
AU - Adamo, Marianna
AU - Ariotti, Sara
AU - Ferrante, Giuseppe
AU - Navarese, Eliano Pio
AU - Leonardi, Sergio
AU - Garcia-Garcia, Hector
AU - Vranckx, Pascal
AU - Valgimigli, Marco
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Aims: It is currently unclear if the location of coronary artery disease affects decision making with regard to dual antiplatelet therapy (DAPT). We investigated if the presence of at least 30% luminal narrowing in the left main (LM) and/or proximal left anterior descending (pLAD) coronary arteries on angiography is an outcome modifier with respect to DAPT duration. Methods and results: In the Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia (PRODIGY) study, 953 (54.3%) patients with and 801 (45.7%) without LM/pLAD lumen narrowing at the qualifying coronary intervention were randomised to six or 24 months of DAPT. Twentyfour month as compared to six-month DAPT reduced the occurrence of definite, probable or possible stent thrombosis by 50% in patients with (2.8% vs. 5.6%; HR 0.45, 95% CI: 0.23-0.89; p=0.02) but not in those without LM/pLAD lumen narrowing, with a highly significant interaction testing (PINT = 0.002). This result remained consistent irrespective of whether stenting was (P: 0.01) or was not (PINT: 0.02) performed in the LM/pLAD. Conclusions: Left main and/or proximal LAD lumen narrowing may be a treatment modifier with respect to the duration of DAPT. Patients fulfilling these angiographic characteristics seem to benefit from a prolonged dual antiplatelet treatment. Trial registration: ClinicalTrials.gov Identifier: NCT00611286
AB - Aims: It is currently unclear if the location of coronary artery disease affects decision making with regard to dual antiplatelet therapy (DAPT). We investigated if the presence of at least 30% luminal narrowing in the left main (LM) and/or proximal left anterior descending (pLAD) coronary arteries on angiography is an outcome modifier with respect to DAPT duration. Methods and results: In the Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia (PRODIGY) study, 953 (54.3%) patients with and 801 (45.7%) without LM/pLAD lumen narrowing at the qualifying coronary intervention were randomised to six or 24 months of DAPT. Twentyfour month as compared to six-month DAPT reduced the occurrence of definite, probable or possible stent thrombosis by 50% in patients with (2.8% vs. 5.6%; HR 0.45, 95% CI: 0.23-0.89; p=0.02) but not in those without LM/pLAD lumen narrowing, with a highly significant interaction testing (PINT = 0.002). This result remained consistent irrespective of whether stenting was (P: 0.01) or was not (PINT: 0.02) performed in the LM/pLAD. Conclusions: Left main and/or proximal LAD lumen narrowing may be a treatment modifier with respect to the duration of DAPT. Patients fulfilling these angiographic characteristics seem to benefit from a prolonged dual antiplatelet treatment. Trial registration: ClinicalTrials.gov Identifier: NCT00611286
KW - Acute coronary syndrome
KW - Clopidogrel
KW - Dual antiplatelet therapy (DAPT)
KW - Left main coronary artery
KW - Proximal left anterior descending coronary artery
KW - Stent thrombosis
UR - http://www.scopus.com/inward/record.url?scp=84962464471&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84962464471&partnerID=8YFLogxK
U2 - 10.4244/EIJY15M08_04
DO - 10.4244/EIJY15M08_04
M3 - Article
AN - SCOPUS:84962464471
VL - 11
SP - e1222-e1230
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 11
ER -