{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T03:17:25Z","timestamp":1778123845672,"version":"3.51.4"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the National Research Foundation","award":["NRF: 2021R1F1A1061337"],"award-info":[{"award-number":["NRF: 2021R1F1A1061337"]}]},{"name":"the National Research Foundation","award":["K1923481"],"award-info":[{"award-number":["K1923481"]}]},{"name":"the National Research Foundation","award":["K2022971"],"award-info":[{"award-number":["K2022971"]}]},{"name":"the National Research Foundation","award":["K2111151"],"award-info":[{"award-number":["K2111151"]}]},{"name":"the National Research Foundation","award":["K2211921"],"award-info":[{"award-number":["K2211921"]}]},{"name":"Korea University Research Fund","award":["NRF: 2021R1F1A1061337"],"award-info":[{"award-number":["NRF: 2021R1F1A1061337"]}]},{"name":"Korea University Research Fund","award":["K1923481"],"award-info":[{"award-number":["K1923481"]}]},{"name":"Korea University Research Fund","award":["K2022971"],"award-info":[{"award-number":["K2022971"]}]},{"name":"Korea University Research Fund","award":["K2111151"],"award-info":[{"award-number":["K2111151"]}]},{"name":"Korea University Research Fund","award":["K2211921"],"award-info":[{"award-number":["K2211921"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Drug-eluting stent (DES) recipients require 6\u201312 months of dual antiplatelet treatment (DAPT) and long-term aspirin mono-antiplatelet treatment (MAPT). Given the diversity of contemporary antiplatelet agents, antiplatelet treatment (APT) selection is becoming more complicated. We evaluated 15-year APT trends based on nationwide prescription data of 79,654 patients who underwent percutaneous coronary intervention (PCI) using DESs from 2002 to 2018 in Korea. DAPT (80.7%) was the most preferred initial APT post-PCI. Many DES recipients received prolonged DAPT (post-PCI 3 years: 41.0%; 10 years: 27.7%). There was a noticeable delay in DAPT-to-MAPT conversion from the mid to late 2000s (after the late-stent thrombosis concerns of first-generation DESs raised); the conversion after that was similar during the 2010s, occurring most robustly at 12\u201318 months post-PCI. Clopidogrel had long and increasingly been used for MAPT, surpassing aspirin. The recent increase in newer P2Y12 inhibitor prescriptions was noted. The patients treated with newer P2Y12 inhibitors were more likely younger men and presented with acute myocardial infarction. Real-world APT is evolving, and guideline\u2013practice gaps exist. Further studies exploring the impact of diverse APT strategies on patient outcomes are expected to provide insights into optimal APT that can sophisticatedly balance the ischemic and bleeding risks.<\/jats:p>","DOI":"10.3390\/jcm12072675","type":"journal-article","created":{"date-parts":[[2023,4,4]],"date-time":"2023-04-04T01:35:59Z","timestamp":1680572159000},"page":"2675","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Fifteen-Year Nationwide Trend in Antiplatelet Treatment among Drug-Eluting Stent Recipients in Korea: Many Patients Receive Very Prolonged Dual-Antiplatelet Treatment, and Newer Drugs Are Replacing the Older Ones"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7735-1763","authenticated-orcid":false,"given":"Sunwon","family":"Kim","sequence":"first","affiliation":[{"name":"Cardiovascular Center, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jong-Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1874-449X","authenticated-orcid":false,"given":"Jungkuk","family":"Lee","sequence":"additional","affiliation":[{"name":"Hanmi Pharmaceuticals, Songpa-gu, Seoul 05545, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong-Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1854-9312","authenticated-orcid":false,"given":"Jin-Seok","family":"Kim","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang-Yup","family":"Lim","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seong Hwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeong-Cheon","family":"Ahn","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5058-6103","authenticated-orcid":false,"given":"Woo-Hyuk","family":"Song","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1056\/NEJMoa012843","article-title":"A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization","volume":"346","author":"Morice","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1038\/nrcardio.2013.13","article-title":"New concepts in the design of drug-eluting coronary stents","volume":"10","author":"Garg","year":"2013","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.amjcard.2018.04.026","article-title":"Results of a 10-Year Experience in Korea Using Drug-Eluting Stents During Percutaneous Coronary Intervention for Acute Myocardial Infarction (from the Korea Acute Myocardial Infarction Registry)","volume":"122","author":"Kim","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.1016\/j.jacc.2011.10.909","article-title":"In-stent neoatherosclerosis: A final common pathway of late stent failure","volume":"59","author":"Park","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1038\/s41569-018-0118-5","article-title":"Predictors of stent thrombosis and their implications for clinical practice","volume":"16","author":"Gori","year":"2019","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e123","DOI":"10.1161\/CIR.0000000000000404","article-title":"2016 ACC\/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF\/AHA\/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF\/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC\/AHA\/ACP\/AATS\/PCNA\/SCAI\/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF\/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA\/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC\/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery","volume":"134","author":"Levine","year":"2016","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/eurheartj\/ehx419","article-title":"2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"39","author":"Valgimigli","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2487","DOI":"10.1016\/S0140-6736(21)01063-1","article-title":"Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): An investigator-initiated, prospective, randomised, open-label, multicentre trial","volume":"397","author":"Koo","year":"2021","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1056\/NEJMoa0706482","article-title":"Prasugrel versus clopidogrel in patients with acute coronary syndromes","volume":"357","author":"Wiviott","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1056\/NEJMoa0904327","article-title":"Ticagrelor versus clopidogrel in patients with acute coronary syndromes","volume":"361","author":"Wallentin","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/bcp.13139","article-title":"Patterns of antiplatelet drug use after a first myocardial infarction during a 10-year period","volume":"83","author":"Yasmina","year":"2017","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1177\/2047487318814970","article-title":"Patterns of treatment with antiplatelet therapy after an acute coronary syndrome: Data from a large database in a community setting","volume":"26","author":"Cimminiello","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e2014008","DOI":"10.4178\/epih\/e2014008","article-title":"A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples","volume":"36","author":"Kim","year":"2014","journal-title":"Epidemiol. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"186","DOI":"10.4258\/hir.2013.19.3.186","article-title":"Stratified sampling design based on data mining","volume":"19","author":"Kim","year":"2013","journal-title":"Healthc. Inform. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"754","DOI":"10.4070\/kcj.2020.0171","article-title":"Cardiovascular Research Using the Korean National Health Information Database","volume":"50","author":"Choi","year":"2020","journal-title":"Korean Circ. J."},{"key":"ref_16","first-page":"799","article-title":"Data Resource Profile: The National Health Information Database of the National Health Insurance Service in South Korea","volume":"46","author":"Kim","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1016\/S0140-6736(13)61720-1","article-title":"Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study","volume":"382","author":"Mehran","year":"2013","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.amjcard.2012.10.030","article-title":"Benefit of long-term dual anti-platelet therapy in patients treated with drug-eluting stents: From the NHLBI dynamic registry","volume":"111","author":"Mulukutla","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1056\/NEJMoa1409312","article-title":"Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents","volume":"371","author":"Mauri","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_20","first-page":"365","article-title":"Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: The OPTIDUAL randomized trial","volume":"37","author":"Helft","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1016\/S0140-6736(14)60612-7","article-title":"Dual-antiplatelet treatment beyond 1 year after drug-eluting stent implantation (ARCTIC-Interruption): A randomised trial","volume":"384","author":"Collet","year":"2014","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1161\/CIRCULATIONAHA.113.003303","article-title":"Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: A randomized, controlled trial","volume":"129","author":"Lee","year":"2014","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1016\/S0140-6736(15)60263-X","article-title":"Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: A pairwise and Bayesian network meta-analysis of randomised trials","volume":"385","author":"Palmerini","year":"2015","journal-title":"Lancet"},{"key":"ref_24","first-page":"390","article-title":"Long-term dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction: A collaborative meta-analysis of randomized trials","volume":"37","author":"Udell","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"l2222","DOI":"10.1136\/bmj.l2222","article-title":"Duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent: Systematic review and network meta-analysis","volume":"365","author":"Yin","year":"2019","journal-title":"BMJ"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1161\/CIRCULATIONAHA.121.056878","article-title":"Estimation of DAPT Study Treatment Effects in Contemporary Clinical Practice: Findings From the EXTEND-DAPT Study","volume":"145","author":"Butala","year":"2022","journal-title":"Circulation"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1016\/j.jacc.2015.01.047","article-title":"Association of spontaneous bleeding and myocardial infarction with long-term mortality after percutaneous coronary intervention","volume":"65","author":"Kazi","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","first-page":"1349","article-title":"Time-dependent associations between actionable bleeding, coronary thrombotic events, and mortality following percutaneous coronary intervention: Results from the PARIS registry","volume":"9","author":"Baber","year":"2016","journal-title":"JACC: Cardiovasc. Interv."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.jacc.2022.11.041","article-title":"P2Y(12) Inhibitor Monotherapy or Dual Antiplatelet Therapy After Complex Percutaneous Coronary Interventions","volume":"81","author":"Gragnano","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1001\/jama.2016.3775","article-title":"Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention","volume":"315","author":"Yeh","year":"2016","journal-title":"JAMA"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S0140-6736(20)32519-8","article-title":"Machine learning-based prediction of adverse events following an acute coronary syndrome (PRAISE): A modelling study of pooled datasets","volume":"397","author":"Gallone","year":"2021","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1161\/CIRCULATIONAHA.112.097014","article-title":"Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: A mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials","volume":"125","author":"Bangalore","year":"2012","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1001\/jama.293.17.2126","article-title":"Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents","volume":"293","author":"Iakovou","year":"2005","journal-title":"JAMA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1056\/NEJMoa067193","article-title":"Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents","volume":"356","author":"Stone","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jacc.2011.03.013","article-title":"Second-generation drug-eluting stents. Moving the field forward","volume":"58","author":"Alfonso","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1056\/NEJMoa1912388","article-title":"Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction","volume":"381","author":"Tardif","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3124","DOI":"10.1093\/eurheartj\/ehx512","article-title":"Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study","volume":"38","author":"Escaned","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e006275","DOI":"10.1161\/CIRCOUTCOMES.119.006275","article-title":"Physician and Hospital Utilization of P2Y12 Inhibitors in ST-Segment-Elevation Myocardial Infarction in the United States: A Study From the National Cardiovascular Data Registry\u2019s Research to Practice Initiative","volume":"13","author":"Faridi","year":"2020","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Samuelsen, P.-J., Eggen, A.E., Steigen, T., Wilsgaard, T., Kristensen, A., Skogsholm, A., Holme, E., van den Heuvel, C., Nordrehaug, J.E., and Bendz, B. (2021). Incidence and risk factors for major bleeding among patients undergoing percutaneous coronary intervention: Findings from the Norwegian Coronary Stent Trial (NORSTENT). PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0247358"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.jacc.2015.06.1323","article-title":"Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention","volume":"66","author":"Genereux","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/j.jcin.2016.04.004","article-title":"Sex-Based Differences in Cessation of Dual-Antiplatelet Therapy Following Percutaneous Coronary Intervention With Stents","volume":"9","author":"Yu","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11886-014-0485-4","article-title":"\u201cEast asian paradox\u201d: Challenge for the current antiplatelet strategy of \u201cone-guideline-fits-all races\u201d in acute coronary syndrome","volume":"16","author":"Jeong","year":"2014","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1038\/nrcardio.2014.104","article-title":"Expert consensus document: World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI","volume":"11","author":"Levine","year":"2014","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"537","DOI":"10.4070\/kcj.2018.0166","article-title":"The evolving concept of dual antiplatelet therapy after percutaneous coronary intervention: Focus on unique feature of East Asian and \u201cAsian Paradox\u201d","volume":"48","author":"Kang","year":"2018","journal-title":"Korean Circ. J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1136\/postgradmedj-2019-137180","article-title":"Efficacy and safety of low dose ticagrelor in patients with acute coronary syndrome: A systematic review and meta-analysis","volume":"96","author":"Chen","year":"2020","journal-title":"Postgrad. Med. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/7\/2675\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:09:20Z","timestamp":1760123360000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/7\/2675"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,3]]},"references-count":45,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["jcm12072675"],"URL":"https:\/\/doi.org\/10.3390\/jcm12072675","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,3]]}}}