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Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease: EXCEL Trial Intravascular Ultrasound to Guide Left Main Stem Intervention: A Sub-Study of the NOBLE Trial Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial Design and rationale for a randomised comparison of everolimus-eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease: the EXCEL trial Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Left Main Coronary Artery Stenosis: A Systematic Review and Meta-analysis Operator Experience and Outcomes After Left Main Percutaneous Coronary Intervention Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: The EXCEL Trial Sex differences in left main coronary artery stenting: Different characteristics but similar outcomes for women compared with men Successful bailout stenting strategy against lethal coronary dissection involving left main bifurcation Quality of Life after Everolimus-Eluting Stents or Bypass Surgery for Treatment of Left Main Disease
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Review Article2017 Dec;70(6):511-517

JOURNAL：J Cardiol. Article Link

Individualized antiplatelet therapy after drug-eluting stent deployment: Implication of clinical trials of different durations of dual antiplatelet therapy

Nakamura M, Kougame N, Iijima R et al. Keywords: Bleeding complication; Drug-eluting stent; Dual antiplatelet therapy; Ischemic event

ABSTRACT

At present, there is consensus that prolonged dual antiplatelet therapy (DAPT) is effective to reduce cardiovascular events at the expense of bleeding complication events. A causal relationship of prolonged DAPT with an increase in mortality remains debatable, however, it appears to be obvious that bleeding complications are associated with an increase in cardiac events. Thus, individualized optimal DAPT duration balancing the risk and benefit of DAPT should be applied. In addition, strategy to minimize bleeding complications is highly recommended. Several risk scores have been reported to discriminate the risk and benefits of DAPT. However, in general, bleeding risk and event risk are correlated with each other, thus predictability of these scores is limited to moderate. Therefore, interpretation of previous trials is important to overcome the shortcome in outcomes. In this review, we provide an overview of DAPT trials and clarify the shortfalls to consider in Japan. Finally, possible future trends with reference to the results of recent clinical trials will be presented.


Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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