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Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography Early Diagnosis of Myocardial Infarction With Point-of-Care High-Sensitivity Cardiac Troponin I Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes Association Between Living in Food Deserts and Cardiovascular Risk Impact of Optimal Medical Therapy on 10-Year Mortality After Coronary Revascularization The Astronaut Cardiovascular Health and Risk Modification (Astro-CHARM) Coronary Calcium Atherosclerotic Cardiovascular Disease Risk Calculator Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC) Canadian Multicenter Chronic Total Occlusion Registry: Ten-Year Follow-Up Results of Chronic Total Occlusion Revascularization Long-Term Outcomes of Biodegradable Versus Second-Generation Durable Polymer Drug-Eluting Stent Implantations for Myocardial Infarction
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Review ArticleVolume 13, Number 6, 2017 Aug 25

JOURNAL：EuroIntervention. Article Link

State of the art: duration of dual antiplatelet therapy after percutaneous coronary intervention and coronary stent implantation - past, present and future perspectives.

Gargiulo G, Valgimigli M, Capodanno D et al. Keywords: percutaneous coronary intervention ; dual antiplatelet therapy; randomised trials

ABSTRACT

Evidence from studies published more than 10 years ago suggested that patients receiving first-generation drug-eluting stents (DES) needed dual antiplatelet therapy (DAPT) for at least 12 months. Current evidence from randomised controlled trials (RCT) reported within the past five years suggests that patients with stable ischaemic heart disease who receive newer-generation DES need DAPT for a minimum of three to six months. Patients who undergo stenting for an acute coronary syndrome benefit from DAPT for at least 12 months, but a Bayesian network meta-analysis confirms that extending DAPT beyond 12 months confers a trade-off between reduced ischaemic events and increased bleeding. However, the network meta-analysis finds no credible increase in all-cause mortality if DAPT is lengthened from three to six months to 12 months (posterior median odds ratio [OR] 0.98; 95% Bayesian credible interval [BCI]: 0.73-1.43), from 12 months to 18-48 months (OR 0.87; 95% BCI: 0.64-1.17), or from three to six months to 18-48 months (OR 0.86; 95% BCI: 0.63-1.21). Future investigation should focus on identifying scoring systems that have excellent discrimination and calibration. Although predictive models should be incorporated into systems of care, most decisions about DAPT duration will be based on clinical judgement and patient preference.
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