Prolonged dual antiplatelet therapy after drug-eluting stent implantation improves long-term prognosis for acute coronary syndrome:five-year results from a large cohort study

BACKGROUND:To investigate the most appropriate dual antiplatelet therapy(DAPT)duration for patients with acute coronary syndrome(ACS)after drug-eluting stent(DES)implantation in the largest cardiovascular center of China.METHODS:We enrolled 5,187 consecutive patients with ACS who received DES from January to December 2013.Patients were divided into four groups based on DAPT duration:standard DAPT group(11-13 months,n=1,568)and prolonged DAPT groups(13-18 months[n=308],18-24 months[n=2,125],and>24 months[n=1,186]).Baseline characteristics and 5-year clinical outcomes were recorded.RESULTS:Baseline characteristics were similar across the four groups.Among the four groups,those with prolonged DAPT(18-24 months)had the lowest incidence of major adverse cardiovascular and cerebrovascular events(MACCEs)(14.1%vs.11.7%vs.9.6%vs.24.2%,P<0.001),all-cause death(4.8%vs.3.9%vs.2.1%vs.2.6%,P<0.001),cardiac death(3.1%vs.2.6%vs.1.4%vs.1.9%,P=0.004),and myocardial infarction(MI)(3.8%vs.4.2%vs.2.5%vs.5.8%,P<0.001).The incidence of bleeding was not different among the four groups(9.9%vs.9.4%vs.11.0%vs.9.4%,P=0.449).Cox multivariable analysis showed that prolonged DAPT(18-24 months)was an independent protective factor for MACCEs(hazard ratio[HR]0.802,95%confidence interval[CI]0.729-0.882,P<0.001),all-cause death(HR 0.660,95%CI 0.547-0.795,P<0.001),cardiac death(HR 0.663,95%CI 0.526-0.835,P<0.001),MI(HR 0.796,95%CI 0.662-0.957,P=0.015),and target vessel revascularization(HR 0.867,95%CI 0.755-0.996,P=0.044).Subgroup analysis for high bleeding risk showed that prolonged DAPT remained an independent protective factor for all-cause death and MACCEs.CONCLUSION:For patients with ACS after DES,appropriately prolonging the DAPT duration may be associated with a reduced risk of adverse ischemic events without increasing the bleeding risk.

Elevated Levels of Very Low？density Lipoprotein Cholesterol Independently Associated with In？stent Restenosis in Diabetic Patients after Drug？eluting Stent Implantation

Background： High rate of in-stent restenosis （ISR） remained an unsolved clinical problem in clinical practice, especially among patients with diabetes mellitus （DM）. Diabetic patients often had hypertriglyceridemia with elevated levels of very low-density lipoprotein cholesterol （VLDL-C）. Increasing evidence suggested that VLDL-C was known as a significant risk factor for atherosclerosis and had been recommended as a treatment target by current dyslipidemia guidelines. However, the role of VLDL-C in the occurrence and development of ISR in coronary artery disease （CAD） patients with DM had not been studied. The aim of this study was to evaluate the association between the elevated levels of VLDL-C and the risk of ISR in CAD patients with DM. Methods： A total of 1390 diabetic patients, who underwent coronary drug-eluting stent （DES） implantation at Beijing Anzhen Hospital and followed up by angiography within 6–24 months, were consecutively enrolled. Patients＇ demographic and clinical characteristics, including age, gender, CAD risk factors, family history, life style, medical history, and coronary angiographic information, were collected carefully at baseline percutaneous coronary intervention and follow-up angiography. Multivariate Cox＆#39;s proportional hazards regression modeling using the step-wise method （entry, 0.05; removal, 0.05） was used to determine the independent risk associated with ISR in diabetic patients. Results： Finally, 1206 of patients were included in this study. ISR occurred in 132/1206 diabetic patients （10.9%） by follow-up angiography. Patients with ISR had elevated median serum VLDL-C levels compared with those without ISR （0.65 mmol/L vs. 0.52 mmol/L, P = 0.030）. The multivariate regression analysis showed that VLDL-C was significantly associated with the risk of ISR in diabetic CAD patients （hazard ratio [HR] = 1.15, 95% confidence interval [CI]： 1.03–1.29, P = 0.017）. The HR for the risk of ISR associated with VLDL-C level ≥0.52 mmol/L was 3.01 （95% CI： 1.24–7.34, P = 0.015）. Conclusion： The elevated level of serum VLDL-C was a significant and independent risk factor for ISR in diabetic CAD patients after coronary DES implantation.

Coronary in-stent restenosis

widely used development incidence of factors and Coronary stent implantation was considered as a way of coronary revascularization. It has been in the treatment of coronary heart disease, but restenosis has become the main bottleneck to the of stent technique. Despite drug-eluting stents used widely, restenosis rate is still about 10%. The restenosis was associated with intervention injury, patient factors, genetic types, nerve endocrine so on Overview above aspects is expected to provide some ideas for restenosis prevention and treatment.