Scholar - SciOpen

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting patients’ quality of life and increasing the risk of death, stroke, heart failure, and dementia. Over the past two decades, there have been significant breakthroughs in AF risk prediction and screening, stroke prevention, rhythm control, catheter ablation, and integrated management. During this period, the scale, quality, and experience of AF management in China have greatly improved, providing a solid foundation for the development of guidelines for the diagnosis and management of AF. To further promote standardized AF management, and apply new technologies and concepts to clinical practice in a timely and comprehensive manner, the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA₂DS₂-VASc-60 stroke risk score based on the characteristics of AF in the Asian population. The guidelines have also reevaluated the clinical application of AF screening, emphasized the significance of early rhythm control, and highlighted the central role of catheter ablation in rhythm control.

Open Access Research Article Issue

Prolonging dual antiplatelet therapy improves the long-term prognosis in patients with diabetes mellitus undergoing complex percutaneous coronary intervention

Jing-Jing XU, Si-Da JIA, Pei ZHU, Ying SONG, De-Shan YUAN, Xue-Yan ZHAO, Yi YAO, Lin JIANG, Jian-Xin LI, Yin ZHANG, Lei SONG, Run-Lin GAO, Ya-Ling HAN, Jin-Qing YUAN

Journal of Geriatric Cardiology 2023, 20(8): 586-595

Published: 30 August 2023

Abstract

PDF (9.3 MB) Collect Collected

Downloads：52

OBJECTIVE

To investigate the optimal duration of dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) requiring complex percutaneous coronary intervention (PCI).

METHODS

A total of 2403 patients with DM who underwent complex PCI from January to December 2013 were consecutively enrolled in this observational cohort study and divided according to DAPT duration into a standard group (11–13 months, n = 689) and two prolonged groups (13–24 months, n = 1133; > 24 months, n = 581).

RESULTS

Baseline characteristics, angiographic findings, and complexity of PCI were comparable regardless of DAPT duration. The incidence of major adverse cardiac and cerebrovascular event was lower when DAPT was 13–24 months than when it was 11–13 months or > 24 months (4.6% vs. 8.1% vs. 6.0%, P = 0.008), as was the incidence of all-cause death (1.9% vs. 4.6% vs. 2.2%, P = 0.002) and cardiac death (1.0% vs. 3.0% vs. 1.2%, P = 0.002). After adjustment for confounders, DAPT for 13–24 months was associated with a lower risk of major adverse cardiac and cerebrovascular event [hazard ratio (HR) = 0.544, 95% CI: 0.373–0.795] and all-cause death (HR = 0.605, 95% CI: 0.387–0.944). DAPT for > 24 months was associated with a lower risk of all-cause death (HR = 0.681, 95% CI: 0.493–0.942) and cardiac death (HR = 0.620, 95% CI: 0.403–0.952). The risk of major bleeding was not increased by prolonging DAPT to 13–24 months (HR = 1.356, 95% CI: 0.766–2.401) or > 24 months (HR = 0.967, 95% CI: 0.682–1.371).

CONCLUSIONS

For patients with DM undergoing complex PCI, prolonging DAPT might improve the long-term prognosis by reducing the risk of adverse ischemic events without increasing the bleeding risk.

Total 2