Comparative Evaluation of Prolonged Dual Antiplatelet Therapy versus Conventional Regimens on Prognosis in Patients with High Residual Inflammatory Risk: Results from a Prospective Observational Study

Introduction: High residual inflammatory risk (hs-CRP≥ 2mg/L) predicts worse prognosis and increased ischemic risk following percutaneous coronary intervention (PCI). The optimal duration of dual antiplatelet therapy (DAPT) and its risk-benefit profile in post-PCI patients with high residual inflammatory risk remain unclear. Methods: Patients undergoing PCI with high residual inflammatory risk at Fuwai Hospital were consecutively enrolled. Patients were stratified into two groups based on DAPT duration: prolonged (> 12 months) and conventional (≤ 12 months) groups. The primary outcome was a composite endpoint of all-cause death, myocardial infarction, definite or probable stent thrombosis, or stroke at 3 years. The key safety outcome was the 3-year rate of Bleeding Academic Research Consortium 2, 3, or 5 bleeding. Results: Among post-PCI patients with high residual inflammatory risk, 2440 individuals (69.5%) continued DAPT beyond 12 months. After three years of follow-up, prolonged DAPT was associated with a significantly lower risk of the primary outcome (1.5% vs. 4.2%; adjusted hazard ratio [HR]: 0.347, 95% CI: 0.224– 0.539). Similar benefits were observed for net adverse clinical events (1.4% vs. 4.1%; adjusted HR: 0.338, 95% CI: 0.216– 0.53) and for the composite endpoint of all-cause death or myocardial infarction (0.6% vs. 3.1%; adjusted HR: 0.182, 95% CI: 0.097– 0.341). Notably, the key safety endpoint did not differ significantly between the two DAPT durations during follow-up (1.0% vs. 1.2%; adjusted HR: 0.793, 95% CI: 0.401– 1.57). Conclusion: In patients who underwent PCI with high residual inflammatory risk, prolonged DAPT improved clinical outcomes by mitigating ischemic risk without increasing clinically significant bleeding. An infographic titled “Comparative Evaluation of Prolonged Dual Antiplatelet Therapy versus Conventional Regimens on Prognosis in Patients with High Residual Inflammatory Risk” presents a study from Fuwai Hospital, Beijing, China, conducted in 2013. It involved patients undergoing PCI with high residual inflammatory risk (hs-CRP ≥ 2 mg/L). The treatment compared was Aspirin + P2Y12 inhibitor for durations of ≤ 1 year and > 1 year. Findings included two plots: MACCE and bleeding. The MACCE plot showed a significant reduction in events with prolonged DAPT (> 1 year) with end values of 6.2% and 2.4% (Log Rank P< 0.001). The bleeding plot showed no significant difference, with end values of 1.4% and 1.1% (Log Rank P=0.482). The conclusion was that prolonged DAPT (> 1 year) reduced 3-year MACCE rates without increasing bleeding risk in patients with high residual inflammatory risk.Infographic comparing prolonged DAPT vs conventional regimens after PCI in patients with high residual inflammatory risk. Keywords: blood platelets, inflammation, percutaneous coronary intervention, high-sensitivity C-reactive protein