P rolonged dual antiplatelet therapy (DAPT) after coronary stenting has been associated with a reduction in ischemic events at the expense of higher bleeding. There is a valuable need to define the “sweet spot” for a specific patient where we optimize the benefits of DAPT with minimal associated risks. Intuitively, lesion complexity is a variable associated with a higher risk for ischemic events; therefore, the decision to extend DAPT duration seems appropriate. This concept is supported by a pooled analysis of different trials demonstrating an additional benefit of prolonged DAPT in patients with complex anatomy (1). This study evaluated the effect of lesion complexity (3 vessels treated, 3 stents implanted, 3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, or chronic total occlusion as the target lesion) upon DAPT duration of 6 months versus 12 months. The definition adopted for lesion complexity was, in our view, more realistic compared with the pre-specified definition applied in the DAPT trial (2). In addition, the study of Giustino et al. (1) evaluated the effect of DAPT between 6 and 12 months and not after 12 months.

中文翻译：

---

双重抗血小板治疗的长期持续时间

冠状动脉支架置入术后延长双联抗血小板治疗 (DAPT) 与减少缺血事件相关，但会增加出血。有必要为特定患者定义“最佳点”，在那里我们以最小的相关风险优化 DAPT 的益处。直观地说，病变复杂性是一个与缺血事件风险较高相关的变量；因此，延长 DAPT 期限的决定似乎是恰当的。这一概念得到了不同试验的汇总分析的支持，表明延长 DAPT 对解剖结构复杂的患者有额外的好处 (1)。本研究评估病变复杂性的影响（治疗 3 个血管，植入 3 个支架，治疗 3 个病变，分叉处植入 2 个支架，支架总长度 >60 mm，或慢性完全闭塞作为目标病变）在 6 个月与 12 个月的 DAPT 持续时间。我们认为，与 DAPT 试验中应用的预先指定的定义相比，针对病变复杂性采用的定义更现实 (2)。此外，Giustino 等人的研究。(1) 在 6 到 12 个月之间而不是在 12 个月之后评估 DAPT 的效果。