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. 2017 Jun 1;89(7):1176-1184.
doi: 10.1002/ccd.26831. Epub 2016 Nov 10.

Long-term outcomes in patients with acute coronary syndromes related to prolonging dual antiplatelet therapy more than 12 months after coronary stenting

Neil J Wimmer  1   2 , Alyssa B Dufour  3   4   5 , Kelly Cho  3   4   6 , David R Gagnon  2   3 , Lien Quach  2   3   7 , Samantha Ly  1 , Jacquelyn-My Do  1 , Simon Ostrowski  1 , J Michael Gaziano  1   2   3   4 , David P Faxon  1   2   4 , Scott Kinlay  1   2   4
Affiliations

Long-term outcomes in patients with acute coronary syndromes related to prolonging dual antiplatelet therapy more than 12 months after coronary stenting

Neil J Wimmer et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: To assess the impact of stent type on the risk of death or myocardial infarction (MI) related to dual antiplatelet therapy (DAPT) more than 12 months (prolonged DAPT) versus 12 or less months after PCI for an acute coronary syndrome (ACS).

Background: The recent DAPT study reported lower recurrent ischemic events from prolonged DAPT in patients treated with PCI for an ACS, but was underpowered to determine the impact of stent type.

Methods: We determined clinical outcomes after PCI for an ACS (median follow-up: DES = 26 months, BMS = 46 months) in 18,484 patients in the Veterans Affairs system treated with first generation drug-eluting stents (DES) or bare-metal stents (BMS). We used landmark analyses starting 1 year after the index PCI to assess the risk of prolonged DAPT on the primary endpoint of death or MI. Multivariable and propensity models adjusted for confounding.

Results: There was a significant interaction between stent type and prolonged DAPT for death and MI (P = 0.0036), death (P = 0.054), and major bleeding (P = 0.0013). Patients treated with prolonged DAPT had lower risks of death or MI (HR = 0.71, 95% CI = 0.61, 0.82) and death (HR = 0.74, 95%CI = 0.62, 0.89) with DES, but not BMS, and higher risks of major bleeding, particularly with BMS (HR = 1.67, P < 0.001) than DES (HR = 1.24, p = 0.01).

Conclusions: Prolonging DAPT more than 12 months after PCI for ACS only associated with a lower risk of ischemic events in the 1-4 years after PCI in those receiving first generation DES. Stent type may influence the benefit of prolonged DAPT. © 2016 Wiley Periodicals, Inc.

Keywords: bare metal; drug-eluting; dual antiplatelet; duration; outcomes.

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Conflict of interest statement

Conflict of interest: No disclosures for NJW, ABD, KC, DRG, SL, JD, SO, JMG, DPF. SK disclosures: research support from Medtronic (SYMPLICITY III Study) and The Medicines Company (ENDOMAX Study).

Figures

Fig. 1
Fig. 1
Flow chart showing patient population and reasons for exclusions. Abbreviations: DES, drug eluting stents; BMS, bare metal stents; CABG, coronary artery bypass grafting; PCI, percutaneous coronary interventions; VA, Veterans Affairs health system; ACS, acute coronary syndrome.
Fig. 2
Fig. 2
Incidence of death or MI (A and B) and death (C and D) between 1 and 4 years after the index ACS event by clopidogrel duration and stent type.
See this image and copyright information in PMC

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