Stent Thrombosis in Drug-Eluting or Bare-Metal Stents in Patients Receiving Dual Antiplatelet Therapy.

Abstract

OBJECTIVES:

This study sought to compare rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE) (composite of death, myocardial infarction, or stroke) after coronary stenting with drug-eluting stents (DES) versus bare-metal stents (BMS) in patients who participated in the DAPT (Dual Antiplatelet Therapy) study, an international multicenter randomized trial comparing 30 versus 12 months of dual antiplatelet therapy in subjects undergoing coronary stenting with either DES or BMS.

BACKGROUND:

Despite antirestenotic efficacy of coronary DES compared with BMS, the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Many clinicians perceive BMS to be associated with fewer adverse ischemic events and to require shorter-duration dual antiplatelet therapy than DES.

METHODS:

Prospective propensity-matched analysis of subjects enrolled into a randomized trial of dual antiplatelet therapy duration was performed. DES- and BMS-treated subjects were propensity-score matched in a many-to-one fashion. The study design was observational for all subjects 0 to 12 months following stenting. A subset of eligible subjects without major ischemic or bleeding events were randomized at 12 months to continued thienopyridine versus placebo; all subjects were followed through 33 months.

RESULTS:

Among 10,026 propensity-matched subjects, DES-treated subjects (n = 8,308) had a lower rate of stent thrombosis through 33 months compared with BMS-treated subjects (n = 1,718, 1.7% vs. 2.6%; weighted risk difference -1.1%, p = 0.01) and a noninferior rate of MACCE (11.4% vs. 13.2%, respectively, weighted risk difference -1.8%, p = 0.053, noninferiority p < 0.001).

CONCLUSIONS:

DES-treated subjects have long-term rates of stent thrombosis that are lower than BMS-treated subjects. (The Dual Antiplatelet Therapy Study [DAPT study]; NCT00977938).

• Authors: Dean J Kereiakes, Robert W Yeh, Joseph M Massaro, Priscilla Driscoll-Shempp, Donald E Cutlip, P Gabriel Steg, Anthony H Gershlick, Harald Darius, Ian T Meredith, John Ormiston, Jean-François Tanguay, Stephan Windecker, Kirk N Garratt, David E Kandzari, David P Lee, Daniel I Simon, Adrian Corneliu Iancu, Jaroslaw Trebacz, Laura Mauri, DAPT Study Investigators
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 8 Issue 12 Pg. 1552-62 (Oct 2015) ISSN: 1876-7605 [Electronic] United States
• PMID: 26493248 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Metals
• Platelet Aggregation Inhibitors

Topics

• Coronary Artery Disease (blood, diagnosis, mortality, therapy)
• Coronary Thrombosis (diagnosis, etiology, mortality, prevention & control)
• Double-Blind Method
• Drug Therapy, Combination
• Drug-Eluting Stents
• Female
• Humans
• Male
• Metals
• Middle Aged
• Myocardial Infarction (etiology, prevention & control)
• Percutaneous Coronary Intervention (adverse effects, instrumentation, mortality)
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Propensity Score
• Prospective Studies
• Prosthesis Design
• Risk Assessment
• Risk Factors
• Stents
• Stroke (etiology, prevention & control)
• Time Factors
• Treatment Outcome