Six-Month Versus 12-Month Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stents

Abstract

Background-The optimal duration of dual antiplatelet therapy (DAPT) after implantation of drug-eluting coronary stents remains undetermined. We aimed to test whether 6-month DAPT would be noninferior to 12-month DAPT after implantation of drug-eluting stents. Methods and Results-We randomly assigned 1443 patients undergoing implantation of drug-eluting stents to receive 6-or 12-month DAPT (in a 1:1 ratio). The primary end point was a target vessel failure, defined as the composite of cardiac death, myocardial infarction, or ischemia-driven target vessel revascularization at 12 months. Rates of target vessel failure at 12 months were 4.8% in the 6-month DAPT group and 4.3% in the 12-month DAPT group (the upper limit of 1-sided 95% confidence interval, 2.4%; Pϭ0.001 for noninferiority with a predefined noninferiority margin of 4.0%). Although stent thrombosis tended to occur more frequently in the 6-month DAPT group than in the 12-month group (0.9% versus 0.1%; hazard ratio, 6.02; 95% confidence interval, 0.72-49.96; Pϭ0.10), the risk of death or myocardial infarction did not differ in the 2 groups (2.4% versus 1.9%; hazard ratio, 1.21; 95% confidence interval, 0.60 -2.47; Pϭ0.58). In the prespecified subgroup analysis, target vessel failure occurred more frequently in the 6-month DAPT group than in the 12-month group (hazard ratio, 3.16; 95% confidence interval, 1.42-7.03; Pϭ0.005) among diabetic patients. Conclusions-Six-month DAPT did not increase the risk of target vessel failure at 12 months after implantation of drug-eluting stents compared with 12-month DAPT. However, the noninferiority margin was wide, and the study was underpowered for death or myocardial infarction. Our results need to be confirmed in larger trials. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00698607. (Circulation. 2012;125:505-513.)

Duration of dual antiplatelet therapy following drug‐eluting stent implantation: A systemic review and meta‐analysis of randomized controlled trials with longer follow up

“…2692 publications were found at initial search and after abstract and manuscript evaluation eleven studies are selected for final analysis ( Figure 1) [3][4][5][6][7][8][9][10][11][12][13]. In selected eleven RCTs, 33, 520 patients were randomized to S-DAPT (N=16, 687) and L-DAPT (n=16,833), respectively.…”

“…duration of DAPT have reported conflicting results [3][4][5][6][7][8][9][10][11][12][13]. Previous meta-analyses of RCTs comparing S-DAPT versus L-DAPT have shown inconsistent results [14][15][16][17].…”

Treatment of a recurrent renal artery stenosis and stent fracture using a drug eluting stent in a pediatric patient

“…In cases, angioplasty had been reported as very useful, but other authors have reported poor long-term results needing the use of stents [1,[10][11][12][13][14][15]. In our patient, the angioplasties performed obtained an excellent immediate result, but really poor intermediate or long-term results.…”

“…Drug eluting stents are normal metallic stents coated with a pharmacological agent that interferes with the process of restenosis [10][11][12]. The use of DES is controversial, and there is not much information on the use of these stents especially in the pediatric population [1,4].…”

“…In our patient the DES reduced the restenosis rate and at 6 months there was still excellent flow with minimal intimal proliferation. Even though, there is controversy of the high risk of thrombosis of these stents, there is information that recommends the use of these DES with dual antiplatelet therapy decreasing the chance of a thrombotic event [12]. The use of DES has been confined to the coronary arteries.…”