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

Francesco Costa, Marianna Adamo, Sara Ariotti, Giuseppe Ferrante, Eliano Pio Navarese, Sergio Leonardi, Hector Garcia-Garcia, Pascal Vranckx, Marco Valgimigli

Research output: Contribution to journalArticle

12 Citations (Scopus)

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 languageEnglish
Pages (from-to)e1222-e1230
JournalEuroIntervention
Volume11
Issue number11
DOIs
Publication statusPublished - Feb 1 2016

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Coronary Artery Disease
Therapeutics
Stents
Tunica Intima
Hyperplasia
Coronary Vessels
Decision Making
Angiography
Thrombosis

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 journalArticle

Costa, Francesco ; Adamo, Marianna ; Ariotti, Sara ; Ferrante, Giuseppe ; Navarese, Eliano Pio ; Leonardi, Sergio ; Garcia-Garcia, Hector ; Vranckx, Pascal ; Valgimigli, Marco. / 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. In: EuroIntervention. 2016 ; Vol. 11, No. 11. pp. e1222-e1230.
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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

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