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Lee CW, Ahn JM, Park DW, Kang SJ, Lee SW, Kim YH, Park SW, Han S, Lee SG, Seong IW, Rha SW, Jeong MH, Lim DS, 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. Optimal Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation. Circulation 2014; 129:304-12. [DOI: 10.1161/circulationaha.113.003303] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01186146.
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Affiliation(s)
- Cheol Whan Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Jung-Min Ahn
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Duk-Woo Park
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Soo-Jin Kang
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seung-Whan Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Young-Hak Kim
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seong-Wook Park
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seungbong Han
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Sang-Gon Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - In-Whan Seong
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seung-Woon Rha
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Myung-Ho Jeong
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Do-Sun Lim
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Jung-Han Yoon
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seung-Ho Hur
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Yun-Seok Choi
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Joo-Young Yang
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Nae-Hee Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Hyun-Sook Kim
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Bong-Ki Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Kee-Sik Kim
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seung-Uk Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Jei-Keon Chae
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Sang-Sig Cheong
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Il-woo Suh
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Hun-Sik Park
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Deuk-Young Nah
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Doo-Soo Jeon
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Ki-Bae Seung
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Keun Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Jae-Sik Jang
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seung-Jung Park
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
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