Dual antiplatelet therapy duration and clinical outcomes following treatment with zotarolimus-eluting stents.
OBJECTIVE
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.
Department of Interventional Cardiology, Piedmont Heart Institute, Suite 300, 275 Collier Road, Atlanta, Georgia 30309, USA. david.kandzari@piedmont.org
David E
DE
Kandzari
Colin S
CS
Barker
Martin B
MB
Leon
Laura
L
Mauri
William
W
Wijns
Jean
J
Fajadet
Roxana
R
Mehran
D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001530:Belgium; D016001:Confidence Intervals; D023903:Coronary Restenosis / Q000188:drug therapy / Q000517:prevention & control* / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005602:France; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017239:Paclitaxel / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D058924:Thienopyridines / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D058924:Thienopyridines; C489443:zotarolimus; D017239:Paclitaxel; D001241:Aspirin; D020123:Sirolimus