Safety and efficacy of antiplatelet therapy in patients with intermediate coronary artery stenosis and deferred revascularization

David Hong; Seung Hun Lee; Jihye Heo; Doosup Shin; Juhee Cho; Eliseo Guallar; Hyun Sung Joh; Hyun Kuk Kim; Junho Ha; Ki Hong Choi; Taek Kyu Park; Jeong Hoon Yang; Young Bin Song; Joo-Yong Hahn; Seung-Hyuk Choi; Hyeon-Cheol Gwon; Danbee Kang; Joo Myung Lee

doi:10.1016/j.rec.2024.11.001

Safety and efficacy of antiplatelet therapy in patients with intermediate coronary artery stenosis and deferred revascularization

Rev Esp Cardiol (Engl Ed). 2024 Nov 13:S1885-5857(24)00331-1. doi: 10.1016/j.rec.2024.11.001. Online ahead of print.

[Article in English, Spanish]

Authors

David Hong¹, Seung Hun Lee², Jihye Heo³, Doosup Shin⁴, Juhee Cho³, Eliseo Guallar⁵, Hyun Sung Joh⁶, Hyun Kuk Kim⁷, Junho Ha¹, Ki Hong Choi¹, Taek Kyu Park¹, Jeong Hoon Yang¹, Young Bin Song¹, Joo-Yong Hahn¹, Seung-Hyuk Choi¹, Hyeon-Cheol Gwon¹, Danbee Kang⁸, Joo Myung Lee⁹

Affiliations

¹ Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
² Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea.
³ Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea; Department of Clinical Research Design and Evaluation, Samsung Advances Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
⁴ Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, United States.
⁵ Department of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
⁶ Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
⁷ Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Republic of Korea.
⁸ Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea; Department of Clinical Research Design and Evaluation, Samsung Advances Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea. Electronic address: dbee.kang@skku.edu.
⁹ Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: joomyung.lee@samsung.com.

PMID: 39542207
DOI: 10.1016/j.rec.2024.11.001

Abstract

Introduction and objectives: This study investigated the safety and efficacy of antiplatelet therapy in patients with intermediate coronary artery stenosis who underwent deferred revascularization due to their fractional flow reserve (FFR).

Methods: A nationwide cohort study was conducted using the Korean National Health Insurance Service database. A total of 4657 patients with intermediate coronary artery stenosis who underwent deferred revascularization due to their FFR were identified from 2013 to 2020. FFR was indicated in patients with no prior evidence of myocardial ischemia and intermediate coronary artery stenosis (50%-70%) as determined by quantitative coronary angiography. Patients were classified according to whether antiplatelet therapy was initiated after the index procedure. The primary efficacy outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, unplanned revascularization, and stroke, during a 5-year follow-up period. The primary safety outcome was any gastrointestinal bleeding.

Results: After propensity score matching, there were 1634 patients in the antiplatelet therapy group and 1634 in the nonantiplatelet therapy group. The risk of MACCE was similar between the 2 groups (24.8% vs 24.7%; adjusted HR, 0.97; 95%CI, 0.84-1.13; P=0.745). The risk of gastrointestinal bleeding was higher in the antiplatelet therapy group than in the nonantiplatelet therapy group (2.2% vs 1.2%; aHR, 2.07; 95%CI, 1.08-4.00). These results were similar in subgroup analyses.

Conclusions: In patients with intermediate coronary artery stenosis who underwent deferred revascularization due to their FFR, antiplatelet therapy may increase the risk of gastrointestinal bleeding without reducing the risk of future ischemic events.

Keywords: Antiplatelet therapy; Estenosis coronaria intermedia; Fractional flow reserve; Intermediate coronary artery stenosis; Prognosis; Pronóstico; Reserva fraccional de flujo; Tratamiento antiplaquetario.