Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation a randomized, controlled trial

Cheol Whan Lee, Jung Min Ahn, Duk Woo Park, Soo Jin Kang, Seung Whan Lee, Young Hak Kim, Seong Wook Park, Seungbong Han, Sang Gon Lee, In Whan Seong, Seung-Woon Rha, Myung Ho Jeong, Do-Sun Lim, Jung Han Yoon, Seung Ho Hur, Yun Seok Choi, Joo Young Yang, Nae Hee Lee, Hyun Sook Kim, Bong Ki LeeKee Sik Kim, Seung Uk Lee, Jei Keon Chae, Sang Sig Cheong, Il Woo Suh, Hun Sik Park, Deuk Young Nah, Doo Soo Jeon, Ki Bae Seung, Keun Lee, Jae Sik Jang, Seung Jung Park

Research output: Contribution to journalArticle

192 Citations (Scopus)

Abstract

Background-The risks and benefits of long-term dual antiplatelet therapy remain unclear. Methods and Results-This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinical centers in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011. Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531). The primary end point was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization. At 24 months, the primary end point occurred in 57 aspirin-alone group patients (2.4%) and 61 dual-therapy group patients (2.6%; hazard ratio, 0.94; 95% confidence interval, 0.66-1.35; P=0.75). The 2 groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent thrombosis, or stroke. Major bleeding occurred in 24 (1.1%) and 34 (1.4%) of the aspirin-alone group and dual-therapy group patients, respectively (hazard ratio, 0.71; 95% confidence interval, 0.42-1.20; P=0.20). Conclusions-Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction, or stroke.

Original languageEnglish
Pages (from-to)304-312
Number of pages9
JournalCirculation
Volume129
Issue number3
DOIs
Publication statusPublished - 2014 Jan 21

Fingerprint

Drug-Eluting Stents
Randomized Controlled Trials
Aspirin
clopidogrel
Stroke
Myocardial Infarction
Group Psychotherapy
Stents
Therapeutics
Confidence Intervals
Hemorrhage
Korea
Random Allocation
Cause of Death
Thrombosis

Keywords

  • Aspirin
  • Clopidogrel
  • Coronary disease
  • Stents

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Lee, C. W., Ahn, J. M., Park, D. W., Kang, S. J., Lee, S. W., Kim, Y. H., ... Park, S. J. (2014). Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation a randomized, controlled trial. Circulation, 129(3), 304-312. https://doi.org/10.1161/CIRCULATIONAHA.113.003303

Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation a randomized, controlled trial. / Lee, Cheol Whan; Ahn, Jung Min; Park, Duk Woo; Kang, Soo Jin; Lee, Seung Whan; Kim, Young Hak; Park, Seong Wook; Han, Seungbong; Lee, Sang Gon; Seong, In Whan; Rha, Seung-Woon; Jeong, Myung Ho; Lim, Do-Sun; Yoon, Jung Han; Hur, Seung Ho; Choi, Yun Seok; Yang, Joo Young; Lee, Nae Hee; Kim, Hyun Sook; Lee, Bong Ki; Kim, Kee Sik; Lee, Seung Uk; Chae, Jei Keon; Cheong, Sang Sig; Suh, Il Woo; Park, Hun Sik; Nah, Deuk Young; Jeon, Doo Soo; Seung, Ki Bae; Lee, Keun; Jang, Jae Sik; Park, Seung Jung.

In: Circulation, Vol. 129, No. 3, 21.01.2014, p. 304-312.

Research output: Contribution to journalArticle

Lee, CW, Ahn, JM, Park, DW, Kang, SJ, Lee, SW, Kim, YH, Park, SW, Han, S, Lee, SG, Seong, IW, Rha, S-W, Jeong, MH, Lim, D-S, Yoon, JH, Hur, SH, Choi, YS, Yang, JY, Lee, NH, Kim, HS, Lee, BK, Kim, KS, Lee, SU, Chae, JK, Cheong, SS, Suh, IW, Park, HS, Nah, DY, Jeon, DS, Seung, KB, Lee, K, Jang, JS & Park, SJ 2014, 'Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation a randomized, controlled trial', Circulation, vol. 129, no. 3, pp. 304-312. https://doi.org/10.1161/CIRCULATIONAHA.113.003303
Lee, Cheol Whan ; Ahn, Jung Min ; Park, Duk Woo ; Kang, Soo Jin ; Lee, Seung Whan ; Kim, Young Hak ; Park, Seong Wook ; Han, Seungbong ; Lee, Sang Gon ; Seong, In Whan ; Rha, Seung-Woon ; Jeong, Myung Ho ; Lim, Do-Sun ; Yoon, Jung Han ; Hur, Seung Ho ; Choi, Yun Seok ; Yang, Joo Young ; Lee, Nae Hee ; Kim, Hyun Sook ; Lee, Bong Ki ; Kim, Kee Sik ; Lee, Seung Uk ; Chae, Jei Keon ; Cheong, Sang Sig ; Suh, Il Woo ; Park, Hun Sik ; Nah, Deuk Young ; Jeon, Doo Soo ; Seung, Ki Bae ; Lee, Keun ; Jang, Jae Sik ; Park, Seung Jung. / Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation a randomized, controlled trial. In: Circulation. 2014 ; Vol. 129, No. 3. pp. 304-312.
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abstract = "Background-The risks and benefits of long-term dual antiplatelet therapy remain unclear. Methods and Results-This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinical centers in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011. Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531). The primary end point was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization. At 24 months, the primary end point occurred in 57 aspirin-alone group patients (2.4{\%}) and 61 dual-therapy group patients (2.6{\%}; hazard ratio, 0.94; 95{\%} confidence interval, 0.66-1.35; P=0.75). The 2 groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent thrombosis, or stroke. Major bleeding occurred in 24 (1.1{\%}) and 34 (1.4{\%}) of the aspirin-alone group and dual-therapy group patients, respectively (hazard ratio, 0.71; 95{\%} confidence interval, 0.42-1.20; P=0.20). Conclusions-Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction, or stroke.",
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AU - Kang, Soo Jin

AU - Lee, Seung Whan

AU - Kim, Young Hak

AU - Park, Seong Wook

AU - Han, Seungbong

AU - Lee, Sang Gon

AU - Seong, In Whan

AU - Rha, Seung-Woon

AU - Jeong, Myung Ho

AU - Lim, Do-Sun

AU - Yoon, Jung Han

AU - Hur, Seung Ho

AU - Choi, Yun Seok

AU - Yang, Joo Young

AU - Lee, Nae Hee

AU - Kim, Hyun Sook

AU - Lee, Bong Ki

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AU - Lee, Seung Uk

AU - Chae, Jei Keon

AU - Cheong, Sang Sig

AU - Suh, Il Woo

AU - Park, Hun Sik

AU - Nah, Deuk Young

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AU - Jang, Jae Sik

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N2 - Background-The risks and benefits of long-term dual antiplatelet therapy remain unclear. Methods and Results-This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinical centers in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011. Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531). The primary end point was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization. At 24 months, the primary end point occurred in 57 aspirin-alone group patients (2.4%) and 61 dual-therapy group patients (2.6%; hazard ratio, 0.94; 95% confidence interval, 0.66-1.35; P=0.75). The 2 groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent thrombosis, or stroke. Major bleeding occurred in 24 (1.1%) and 34 (1.4%) of the aspirin-alone group and dual-therapy group patients, respectively (hazard ratio, 0.71; 95% confidence interval, 0.42-1.20; P=0.20). Conclusions-Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction, or stroke.

AB - Background-The risks and benefits of long-term dual antiplatelet therapy remain unclear. Methods and Results-This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinical centers in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011. Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531). The primary end point was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization. At 24 months, the primary end point occurred in 57 aspirin-alone group patients (2.4%) and 61 dual-therapy group patients (2.6%; hazard ratio, 0.94; 95% confidence interval, 0.66-1.35; P=0.75). The 2 groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent thrombosis, or stroke. Major bleeding occurred in 24 (1.1%) and 34 (1.4%) of the aspirin-alone group and dual-therapy group patients, respectively (hazard ratio, 0.71; 95% confidence interval, 0.42-1.20; P=0.20). Conclusions-Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction, or stroke.

KW - Aspirin

KW - Clopidogrel

KW - Coronary disease

KW - Stents

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