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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 Operator Experience and Outcomes After Left Main Percutaneous Coronary Intervention Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Left Main Coronary Artery Stenosis: A Systematic Review and Meta-analysis 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 Quality of Life after Everolimus-Eluting Stents or Bypass Surgery for Treatment of Left Main Disease Successful bailout stenting strategy against lethal coronary dissection involving left main bifurcation
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Editorial2019;321(24):2409-2411.

JOURNAL：JAMA. Article Link

Dual Antiplatelet TherapyIs It Time to Cut the Cord With Aspirin?

KM Ziada; DJ Moliterno et al. Keywords: DAPT; 1-month clopidogrel vs. 12 month aspirin and clopidogrel; clinical outcomes; 3 years

ABSTRACT

Since evidence of increased risk of stent thrombosis with first-generation drug-eluting stents surfaced in 20051,2 and the US Food and Drug Administration advised interventional cardiologists to use dual antiplatelet therapy (DAPT) for 12 months following implantation of drug-eluting stents, the appropriate duration of DAPT has been widely studied and hotly debated. Dual antiplatelet therapy consists of concurrent administration of aspirin and a P2Y12 inhibitor. Determining the duration of DAPT requires a balance between 2 objectives: lowering the risk of ischemic events with more intense and longer antiplatelet therapy vs lowering the risk of bleeding events with less intense and shorter antiplatelet therapy. Because second-generation drug-eluting stents are associated with lower rates of stent thrombosis,3 the argument against longer DAPT was revisited. The updated guidelines incorporated such considerations by recommending a shorter duration of DAPT for selected patients, namely those with stable clinical status in whom risk of ischemic events is low.4,5

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