Dual Antiplatelet Therapy Duration and Clinical Outcomes Following Treatment With Zotarolimus-Eluting Stents

• Published in: JACC. Cardiovascular interventions 2011-10, Vol.4 (10), p.1119-1128
• Main Authors: Kandzari, David E., MD, Barker, Colin S., MD, Leon, Martin B., MD, Mauri, Laura, MD, MSc, Wijns, William, MD, PhD, Fajadet, Jean, MD, Mehran, Roxana, MD
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents, Phytogenic - therapeutic use; antiplatelet therapy; Aspirin - therapeutic use; Belgium; Cardiovascular; Confidence Intervals; Coronary Restenosis - drug therapy; Coronary Restenosis - prevention & control; Coronary Restenosis - therapy; drug-eluting stent(s); Drug-Eluting Stents - adverse effects; Female; France; Humans; Immunosuppressive Agents - adverse effects; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Paclitaxel - therapeutic use; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Risk Assessment; Sirolimus - adverse effects; Sirolimus - analogs & derivatives; Sirolimus - therapeutic use; stent thrombosis; Thienopyridines - adverse effects; Thienopyridines - therapeutic use; Time Factors; Treatment Outcome; United States; zotarolimus-eluting stent(s)
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2011.06.017

Objectives We sought to evaluate differences in late safety outcomes relative to dual antiplatelet therapy (DAPT) duration in patients treated with zotarolimus-eluting stents (ZES). Background Despite treatment recommendations for at least 12 months of DAPT following drug-eluting stent revascularization, device-specific outcomes relative to DAPT duration are absent. Methods Among 2,032 patients undergoing percutaneous coronary revascularization with ZES in 5 trials, late safety events were compared relative to DAPT duration for patients with ≥6 months DAPT adherence and survival free of major ischemic and bleeding events. Results A total of 1,414 event-free patients on DAPT at 6 months were identified. Patient group comparisons relative to DAPT included: 6 months versus ≥12 months, and 6 months versus ≥24 months. Through 3 years, risk-adjusted ischemic event rates did not significantly differ between groups: 6 versus ≥12 months: death (2.7% vs. 2.2%), myocardial infarction (MI, 0.3% vs. 1.1%), and definite/probable stent thrombosis (ST, 0.3% vs. 0%); 6 versus ≥24 months: death (1.6% vs. 1.6%), MI (0.4% vs. 1.2%), and definite/probable ST (0.1% vs. 0.2%). Composite events also did not statistically vary between DAPT durations. In multivariable analysis, 6-month versus longer DAPT duration was not associated with increased likelihood of thrombotic events at 3-year follow-up. Major bleeding was negligible across groups. Conclusions Among patients treated with ZES, late-term events of death, MI, stroke, and ST do not significantly differ between patients taking 6 months DAPT compared with continuation beyond 1 year. These findings merit further study to identify the appropriate duration of DAPT according to specific drug-eluting stents.