Benefit of long-term dual anti-platelet therapy in patients treated with drug-eluting stents: from the NHLBI dynamic registry.

Abstract

The optimal duration of dual-antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is an important, unanswered question. This study was designed to evaluate the association of varying durations of DAPT on clinical outcomes after DES implantation for the treatment of coronary artery disease. Using the National Heart, Lung, and Blood Institute Dynamic Registry, patients enrolled in the last 2 waves after index percutaneous coronary intervention with DES and who were event free at the time of landmark analysis were included. Landmark analysis was performed 12 and 24 months after percutaneous coronary intervention, and patients were stratified according to continued use of DAPT or not. Subjects were evaluated for rates of death, myocardial infarction, and stent thrombosis at 4 years from their index procedures. The numbers of evaluable patients were 2,157 and 1,918 for the 12- and 24-month landmarks, respectively. In both landmark analyses, there was a significantly lower 4-year rate of death or myocardial infarction in the group that continued DAPT compared to the group that did not (12 months: 10.5% vs 14.5%, p = 0.01; 24 months: 5.7% vs 8.6%, p = 0.02). Beneficial differences in the group that continued on DAPT were preserved after multivariate and propensity adjustment. There were no significant differences in definite stent thrombosis in either landmark analysis. In conclusion, at 12 and 24 months after DES implantation, continued use of DAPT was associated with lower 4-year risk for death and myocardial infarction.

• Authors: Suresh R Mulukutla, Oscar C Marroquin, Helen A Vlachos, Faith Selzer, Catalin Toma, Kevin E Kip, J Dawn Abbott, Elizabeth Holper, Joon S Lee, Sameer Khandhar, Michael Kutcher, Sheryl Kelsey, Conrad Smith, David Faxon, David O Williams
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 111 Issue 4 Pg. 486-92 (Feb 15 2013) ISSN: 1879-1913 [Electronic] United States
• PMID: 23211356 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents, Phytogenic
• Immunosuppressive Agents
• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine
• Paclitaxel
• Aspirin
• Sirolimus

Topics

• Antineoplastic Agents, Phytogenic (pharmacology)
• Aspirin (administration & dosage)
• Clopidogrel
• Coronary Artery Disease (epidemiology, therapy)
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Drug-Eluting Stents
• Follow-Up Studies
• Humans
• Immunosuppressive Agents (pharmacology)
• Paclitaxel (pharmacology)
• Percutaneous Coronary Intervention (methods)
• Platelet Aggregation Inhibitors (administration & dosage)
• Recurrence
• Registries
• Retrospective Studies
• Sirolimus (pharmacology)
• Survival Rate (trends)
• Ticlopidine (administration & dosage, analogs & derivatives)
• Time Factors
• Treatment Outcome
• United States (epidemiology)