title: Beneficial impact of prolonged dual antiplatelet therapy after drug-eluting stent implantation.
abstract: BACKGROUND
  Twelve-month dual antiplatelet therapy (DAT) with aspirin and clopidogrel after drug-eluting stent (DES) implantation is routinely recommended. It is unclear if prolonged (>12-month) DAT is also favorable. We compared the outcome of patients discontinuing DAT 12 months after off-label DES implantation versus those with DAT for >12 months.
  
  
  METHODS
  Baseline, treatment, and outcome data of patients undergoing off-label DES implantation and free from events 11.5 months after index procedure were retrospectively retrieved. Those discontinuing DAT between 11.5 and 12.5 months (12-month DAT group) were compared to those discontinuing DAT after 12.5 months (>12-month DAT group). The primary end-point was the long-term (>24-month) rate of major adverse cerebro-cardiovascular events (MACCE).
  
  
  RESULTS
  Two hundred seventy-two patients met study inclusion criteria: 133 (48.9%) in the 12-month DAT group and 139 (51.1%) in the >12-month DAT group (who were on DAT for an average of 24 months). After an average of 36 months after DES implantation, 14 patients (5.1%) developed MACCE, with 6 (3.5%) cardiac deaths, 7 (2.2%) myocardial infarctions, no stroke, and 5 (1.8%) repeat revascularizations. The >12-month DAT group had a significantly lower risk of MACCE (1 [0.7%] vs. 13 [9.8%] in the 12-month DAT group, P < 0.001) and myocardial infarction (0 vs. 7 [5.3%], P = 0.006), with such differences confirmed at multivariable propensity-adjusted analyses. No significant differences in terms of minor or major bleedings occurred.
  
  
  CONCLUSIONS
  In this retrospective registry, patients with off-label DES implantation receiving prolonged (>12 months) DAT presented with lower rates of MACCE and myocardial infarction.
authors.affiliation: Cardiovascular, Respiratory, Geriatric and Nephrologic Sciences Department, Umberto I Hospital, Sapienza, Italy. rino.sardella@uniroma1.it
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
authors.forename: Massimo
authors.initials: M
authors.lastname: Mancone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Giulia
authors.initials: G
authors.lastname: Conti
authors.forename: Emanuele
authors.initials: E
authors.lastname: Canali
authors.forename: Rocco
authors.initials: R
authors.lastname: Stio
authors.forename: Luigi
authors.initials: L
authors.lastname: Lucisano
authors.forename: Simone
authors.initials: S
authors.lastname: Calcagno
authors.forename: Carlotta
authors.initials: C
authors.lastname: de Carlo
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization; D056687:Off-Label Use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012042:Registries; D019233:Retreatment / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin