CORRIGENDUM: Dual Antiplatelet Therapy Duration After Multivessel Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention

The authors apologize for this correction in the original manuscript. Corrections are shown below.

1) Page 1661, abstract

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Methods and Results: In the OPTIVUS-Complex PCI study multivessel cohort enrolling 982 patients undergoing multivessel PCI, including left anterior descending coronary artery using intravascular ultrasound (IVUS), we conducted 90-day landmark analyses to compare shorter and longer DAPT. DAPT discontinuation was defined as withdrawal of P2Y₁₂ inhibitors or aspirin for at least 2 months. The prevalence of acute coronary syndrome and high bleeding risk by the Bleeding Academic Research Consortium were 14.2% and 52.5%, respectively. The cumulative incidence of DAPT discontinuation was 22.6% at 90 days, and 68.8% at 1 year. In the 90-day landmark analyses, there were no differences in the incidences of a composite of death, myocardial infarction, stroke, or any coronary revascularization (5.9% vs. 9.2%, log-rank P=0.12; adjusted hazard ratio, 0.59; 95% confidence interval, 0.32–1.08; P=0.09) and BARC type 3 or 5 bleeding (1.4% vs. 1.9%, log-rank P=0.62) between the off- and on-DAPT groups at 90 days.

Correct:

Methods and Results: In the OPTIVUS-Complex PCI study multivessel cohort enrolling 978 patients undergoing multivessel PCI, including left anterior descending coronary artery using intravascular ultrasound (IVUS), we conducted 90-day landmark analyses to compare shorter and longer DAPT. DAPT discontinuation was defined as withdrawal of P2Y₁₂ inhibitors or aspirin for at least 2 months. The prevalence of acute coronary syndrome and high bleeding risk by the Bleeding Academic Research Consortium were 14.1% and 52.5%, respectively. The cumulative incidence of DAPT discontinuation was 22.6% at 90 days, and 68.9% at 1 year. In the 90-day landmark analyses, there were no differences in the incidences of a composite of death, myocardial infarction, stroke, or any coronary revascularization (5.9% vs. 9.1%, log-rank P=0.13; adjusted hazard ratio, 0.60; 95% confidence interval, 0.35–1.15; P=0.10) and BARC type 3 or 5 bleeding (1.4% vs. 1.9%, log-rank P=0.62) between the off- and on-DAPT groups at 90 days.

2) Page 1663, left column, line 12–13

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the current study population for the 90-day landmark analyses consisted of 982 patients (Figure 1).

Correct:

the current study population for the 90-day landmark analyses consisted of 978 patients (Figure 1).

3) Pages 1663–1666, Results, “Antiplatelet Therapy and DAPT Discontinuation” section

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Antiplatelet Therapy and DAPT Discontinuation

In the entire study population, the cumulative incidence of DAPT discontinuation was 22.6% at 90 days, and 68.8% at 1 year (Figure 2A). The cumulative incidence of DAPT discontinuation was 90.2% at 90 days and 96.7% at 1 year in patients taking oral anticoagulants, and was 15.6% at 90 days and 65.9% at 1 year in patients not taking oral anticoagulants (Supplementary Figure 1). In the off-DAPT group, the cumulative incidence of DAPT discontinuation was 39.6% at 30 days, 74.8% at 60 days, and 100% at 90 days (Figure 2B), and the median interval from the index PCI to DAPT discontinuation was 36 (IQR: 0–61) days (Table 1). In the on-DAPT group, the cumulative incidence of DAPT discontinuation was 18.7% at 180 days, and 59.6% at 1 year (Figure 2B), and the median interval from the index PCI to DAPT discontinuation was 211 (IQR: 156–264) days (Table 1). At discharge from the index hospitalization for PCI, clopidogrel was more often selected as the P2Y₁₂ inhibitor in the off-DAPT group than in the on-DAPT group (65.8% vs. 52.5%) (Table 1). In terms of the type of antiplatelet monotherapy after DAPT discontinuation, P2Y₁₂ inhibitors were more often selected in the off-DAPT group than in the on-DAPT group (78.4% vs. 50.9%).

Correct:

Antiplatelet Therapy and DAPT Discontinuation

In the entire study population, the cumulative incidence of DAPT discontinuation was 22.6% at 90 days, and 68.9% at 1 year (Figure 2A). The cumulative incidence of DAPT discontinuation was 90.2% at 90 days and 96.7% at 1 year in patients taking oral anticoagulants, and was 15.6% at 90 days and 65.9% at 1 year in patients not taking oral anticoagulants (Supplementary Figure 1). In the off-DAPT group, the cumulative incidence of DAPT discontinuation was 39.4% at 30 days, 74.7% at 60 days, and 100% at 90 days (Figure 2B), and the median interval from the index PCI to DAPT discontinuation was 36 (IQR: 0–61) days (Table 1). In the on-DAPT group, the cumulative incidence of DAPT discontinuation was 18.8% at 180 days, and 59.9% at 1 year (Figure 2B), and the median interval from the index PCI to DAPT discontinuation was 211 (IQR: 146–264) days (Table 1). At discharge from the index hospitalization for PCI, clopidogrel was more often selected as the P2Y₁₂ inhibitor in the off-DAPT group than in the on-DAPT group (65.6% vs. 52.7%) (Table 1). In terms of the type of antiplatelet monotherapy after DAPT discontinuation, P2Y₁₂ inhibitors were more often selected in the off-DAPT group than in the on-DAPT group (78.7% vs. 49.8%).

4) Page 1666, “Baseline Characteristics” section

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Baseline Characteristics

The mean age was 71.1 years, and 14.2% of the patients presented as acute coronary syndrome (Table 1). The prevalence of ARC-HBR and Japanese version HBR (J-HBR) was 52.5% and 63.2%, respectively. Patients in the off-DAPT group were older and more often had comorbidities such as heart failure, systolic left ventricular dysfunction, chronic kidney disease, and atrial fibrillation compared with the on-DAPT group (Table 1). The prevalence of ARC-HBR and J-HBR was higher in the off-DAPT group than in the on-DAPT group (68.0% vs. 48.0%, P<0.001 and 73.4% vs. 60.3%, P<0.001, respectively).

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Baseline Characteristics

The mean age was 71.2 years, and 14.1% of the patients presented as acute coronary syndrome (Table 1). The prevalence of ARC-HBR and Japanese version HBR (J-HBR) was 52.5% and 63.2%, respectively. Patients in the off-DAPT group were older and more often had comorbidities such as heart failure, systolic left ventricular dysfunction, chronic kidney disease, and atrial fibrillation compared with the on-DAPT group (Table 1). The prevalence of ARC-HBR and J-HBR was higher in the off-DAPT group than in the on-DAPT group (68.3% vs. 47.8%, P<0.001 and 73.8% vs. 60.1%, P<0.001, respectively).

5) Page 1668, “Follow-up CAG” section

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Follow-up CAG

The cumulative incidence of follow-up CAG at 1 year was lower in the off-DAPT group than in the on-DAPT group (8.7% vs. 20.3%, log-rank P<0.001) (Supplementary Figure 2).

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Follow-up CAG

The cumulative incidence of follow-up CAG at 1 year was lower in the off-DAPT group than in the on-DAPT group (8.8% vs. 20.2%, log-rank P<0.001) (Supplementary Figure 2).

6) Page 1668, “Clinical Outcomes” section

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Clinical Outcomes

The cumulative 1-year incidence of the primary endpoint was not different between the off- and on-DAPT groups (5.9% vs. 9.2%, log-rank P=0.12) (Figure 3). After adjusting confounders, the effect of off-DAPT relative to on-DAPT was not significant for the primary endpoint (HR, 0.59; 95% CI, 0.32–1.08; P=0.09) (Table 3).

(an omission)

In the analyses after excluding patients who were on oral anticoagulants at discharge, the cumulative 1-year incidences of the primary endpoint and BARC type 3 or 5 bleeding were not different between groups (5.1% vs. 9.2%; HR, 0.54; 95% CI, 0.25–1.17; P=0.12; and 1.4% vs. 2.9%; HR, 0.49; 95% CI, 0.11–2.08; P=0.33) (Supplementary Table 2).

Correct:

Clinical Outcomes

The cumulative 1-year incidence of the primary endpoint was not different between the off- and on-DAPT groups (5.9% vs. 9.1%, log-rank P=0.13) (Figure 3). After adjusting confounders, the effect of off-DAPT relative to on-DAPT was not significant for the primary endpoint (HR, 0.60; 95% CI, 0.33–1.10; P=0.10) (Table 3).

(an omission)

In the analyses after excluding patients who were on oral anticoagulants at discharge, the cumulative 1-year incidences of the primary endpoint and BARC type 3 or 5 bleeding were not different between groups (5.1% vs. 9.1%; HR, 0.55; 95% CI, 0.25–1.19; P=0.13; and 0.7% vs. 1.9%; HR, 0.38; 95% CI, 0.05–2.92; P=0.35) (Supplementary Table 2).

7) Page 1669, right column, line 4–5

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The cumulative incidence of DAPT discontinuation was only 22.6% at 90 days and 68.8% at 1 year,

Correct:

The cumulative incidence of DAPT discontinuation was only 22.6% at 90 days and 68.9% at 1 year,

8) Page 1664, Table 1 (Corrected)

9) Page 1667, Table 2 (Corrected)

10) Page 1669, Table 3 (Corrected)

11) Page 1662, Figure 1 (Corrected)

Figure 1.

Study flowchart.BARC, Bleeding Academic Research Consortium; DAPT, dual antiplatelet therapy; IVUS, intravascular ultrasound; LAD, left anterior descending coronary artery; OPTIVUS, OPTimal IntraVascular UltraSound; PCI, percutaneous coronary intervention.

12) Page 1666, Figure 2

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Figure 2.

Kaplan-Meier curve for DAPT discontinuation (A) in the entire study population, and (B) in the off- and on-DAPT groups at 90 days. The cumulative incidence was estimated with the Kaplan-Meier method. DAPT discontinuation was defined as withdrawal of P2Y₁₂ inhibitor or aspirin for at least 2 months. DAPT, dual antiplatelet therapy; PCI, percutaneous coronary intervention.

13) Page 1668, Figure 3

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Figure 3.

Kaplan-Meier curve for the primary endpoint. The cumulative 1-year incidence was estimated with the Kaplan-Meier method, and the difference was assessed with the log-rank test. DAPT, dual antiplatelet therapy; PCI, percutaneous coronary intervention.

14) Page 1670, Figure 4

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Figure 4.

Kaplan-Meier curve for BARC type 3 or 5 bleeding. The cumulative 1-year incidence was estimated with the Kaplan-Meier method, and the difference was assessed with the log-rank test. BARC, Bleeding Academic Research Consortium; DAPT, dual antiplatelet therapy; PCI, percutaneous coronary intervention.

15) Supplementary File, Supplementary Table 1 (Corrected)

16) Supplementary File, Supplementary Table 2 (Corrected)

17) Supplementary File, Supplementary Figure 2

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18) Supplementary File, Supplementary Figure 3

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19) Supplementary File, Supplementary Figure 4

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