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Prolonged dual antiplatelet therapy did not affect survival after left main artery stenting (Hong Kong Left Main Stenting Registry)

Session Poster session 5

Speaker Chi Yeung Cheung

Congress : ESC Congress 2017

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Coronary Intervention: Adjunctive Pharmacotherapy
  • Session type : Poster Session
  • FP Number : P4292

Authors : PT Tsui (Hong Kong,HK), CL Chan (Hong Kong,HK), KC Chan (Hong Kong,HK), CY Cheung (Hong Kong,HK), LW Tam (Hong Kong,HK), KY Lee (Hong Kong,HK), KL Tsui (Hong Kong,HK), MH Jim (Hong Kong,HK), EB Wu (Hong Kong,HK), YH Chan (Hong Kong,HK), ML Wong (Hong Kong,HK), TS Tse (Hong Kong,HK)

Authors:
P.T. Tsui1 , C.L. Chan2 , K.C. Chan3 , C.Y. Cheung4 , L.W. Tam2 , K.Y. Lee3 , K.L. Tsui4 , M.H. Jim5 , E.B. Wu6 , Y.H. Chan7 , M.L. Wong8 , T.S. Tse9 , 1Princess Margaret Hospital - Hong Kong - Hong Kong SAR People's Republic of China , 2Kwong Wah Hospital - Hong Kong - Hong Kong SAR People's Republic of China , 3Queen Elizabeth Hospital - Hong Kong - Hong Kong SAR People's Republic of China , 4Pamela Youde Nethersole Eastern Hospital - Hong Kong - Hong Kong SAR People's Republic of China , 5Grantham Hospital - Hong Kong - Hong Kong SAR People's Republic of China , 6Prince of Wales University Hospital - Hong Kong - Hong Kong SAR People's Republic of China , 7Pok Oi Hospital - Hong Kong - Hong Kong SAR People's Republic of China , 8Baptist Hospital - Hong Kong - Hong Kong SAR People's Republic of China , 9Saint Paul Hospital - Hong Kong - Hong Kong SAR People's Republic of China ,

On behalf: HKSTENT

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 879

Background: Prolonged dual antiplatelet therapy (DAPT) after coronary stenting might reduce incidence of stent thrombosis at the expense of higher bleeding risk. There was conflicting evidence for effect of prolonged DAPT on survival. The aim of this retrospective study was to examine the effect of prolonged DAPT on survival in left main disease treated with drug eluting stent (DES).

Methods: From January 2007 to December 2010, 550 consecutive patients who underwent left main stenting in 8 public hospitals of Hong Kong were recruited for retrospective analysis. Clinical follow up data were collected up till 30 June 2014. Subgroup (389 patients) analysis was performed in DES patients who survived the first year without major adverse cardiac event (MACE).

Results: The mean age was 68±11 years with male predominance (74%). Diabetes mellitus, hypertension, hypercholesterolemia and smoking history was present in 158 (41%), 247 (64%), 296 (76%) and 161 (41%) patients respectively. Prior myocardial infarction (MI), prior stroke, peripheral vascular disease and creatinine >200 mmol/L (CRI) was found in 136 (35%), 36 (9%), 6 (1.5%), and 12 (3%) patients respectively. Intravascular ultrasonography was performed in 307 (79%) patients. High pressure post-dilatation was performed in 338 (87%) patients. One hundred ninety-two (49%) patients received prolonged DAPT beyond one year. By cox proportional hazard function analysis, old age, prior stroke, CRI were independent predictors of medium term (262±74 weeks) all-causes death. The hazard ratio for prolonged DAPT group was 1.08 (95% confidence interval 0.55–2.10). Stent thrombosis, nonfatal MI and major bleeding rate beyond the first year after implantation of DES was 0.3%, 1% and 0.6% per year respectively for patients receiving just one year DAPT while the corresponding figure was 0.5%, 0.7% and 0.9% per year for patients receiving prolonged DAPT.

Conclusion: For patients without MACE at one year after implantation of DES in left main artery, prolonging DAPT did not affect medium term survival.

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It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members



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