Benefits and Risks of Extended Dual Antiplatelet Therapy After Everolimus-Eluting Stents.

Hermiller, James B; Krucoff, Mitchell W; Kereiakes, Dean J; Windecker, Stephan; Steg, P Gabriel; Yeh, Robert W; Cohen, David J; Cutlip, Donald E; Massaro, Joseph M; Hsieh, Wen-Hua; Mauri, Laura (2016). Benefits and Risks of Extended Dual Antiplatelet Therapy After Everolimus-Eluting Stents. JACC. Cardiovascular Interventions, 9(2), pp. 138-147. Elsevier 10.1016/j.jcin.2015.10.001

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OBJECTIVES The purpose of this study was to characterize outcomes for everolimus-eluting stent (EES)-treated subjects according to treatment with continued thienopyridine plus aspirin versus aspirin alone 12 to 30 months after stenting. BACKGROUND In the DAPT (Dual Antiplatelet Therapy) study, continued thienopyridine plus aspirin beyond 1 year after coronary stenting reduced ischemic events. Given low rates of stent thrombosis and myocardial infarction (MI) for current drug-eluting stents, we examined outcomes among EES-treated subjects in the DAPT study. METHODS The DAPT study enrolled 25,682 subjects (11,308 EES-treated) after coronary stenting. Following 12 months of treatment with thienopyridine and aspirin, eligible subjects continued treatment with aspirin and 9,961 (4,703 with EES) were randomized to 18 months of continued thienopyridine or placebo. Stent type was not randomized, and the EES subset analysis was post hoc. RESULTS Among EES-treated patients, continued thienopyridine reduced stent thrombosis (0.3% vs. 0.7%, hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.15 to 0.97; p = 0.04) and MI (2.1% vs. 3.2%, HR: 0.63, 95% CI: 0.44 to 0.91; p = 0.01) versus placebo but did not reduce a composite of death, MI, and stroke (4.3% vs. 4.5%, HR: 0.89, 95% CI: 0.67 to 1.18; p = 0.42), and increased moderate/severe bleeding (2.5% vs. 1.3%, HR: 1.79, 95% CI: 1.15 to 2.80; p = 0.01), and death (2.2% vs. 1.1%, HR: 1.80, 95% CI: 1.11 to 2.92; p = 0.02). Death due to cancer and not related to bleeding was increased (0.64% vs. 0.17%; p = 0.01). CONCLUSIONS In EES-treated subjects, significant reductions in stent thrombosis and MI and an increase in bleeding were observed with continued thienopyridine beyond 1 year compared with aspirin alone. (The Dual Antiplatelet Therapy Study [DAPT Study]); NCT00977938).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Judith Liniger

Date Deposited:

28 Dec 2016 17:27

Last Modified:

24 Sep 2017 11:25

Publisher DOI:

10.1016/j.jcin.2015.10.001

PubMed ID:

26793956

Uncontrolled Keywords:

drug-eluting stent(s); dual antiplatelet therapy; everolimus; stent thrombosis

BORIS DOI:

10.7892/boris.90384

URI:

https://boris.unibe.ch/id/eprint/90384

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