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.