title: Short- versus long-term duration of dual-antiplatelet therapy after coronary stenting: a randomized multicenter trial.
abstract: BACKGROUND
  The optimal duration of dual-antiplatelet therapy and the risk-benefit ratio for long-term dual-antiplatelet therapy after coronary stenting remain poorly defined. We evaluated the impact of up to 6 versus 24 months of dual-antiplatelet therapy in a broad all-comers patient population receiving a balanced proportion of Food and Drug Administration-approved drug-eluting or bare-metal stents.
  
  
  RESULTS
  We randomly assigned 2013 patients to receive bare-metal, zotarolimus-eluting, paclitaxel-eluting, or everolimus-eluting stent implantation. At 30 days, patients in each stent group were randomly allocated to receive up to 6 or 24 months of clopidogrel therapy in addition to aspirin. The primary end point was a composite of death of any cause, myocardial infarction, or cerebrovascular accident. The cumulative risk of the primary outcome at 2 years was 10.1% with 24-month dual-antiplatelet therapy compared with 10.0% with 6-month dual-antiplatelet therapy (hazard ratio, 0.98; 95% confidence interval, 0.74-1.29; P=0.91). The individual risks of death, myocardial infarction, cerebrovascular accident, or stent thrombosis did not differ between the study groups; however, there was a consistently greater risk of hemorrhage in the 24-month clopidogrel group according to all prespecified bleeding definitions, including the recently proposed Bleeding Academic Research Consortium classification.
  
  
  CONCLUSIONS
  A regimen of 24 months of clopidogrel therapy in patients who had received a balanced mixture of drug-eluting or bare-metal stents was not significantly more effective than a 6-month clopidogrel regimen in reducing the composite of death due to any cause, myocardial infarction, or cerebrovascular accident.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00611286.
authors.affiliation: University of Ferrara, Cardiovascular Institute, Arcispedale S. Anna Hospital, Ferrara, Italy. vlgmrc@unife.it
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.forename: Monia
authors.initials: M
authors.lastname: Monti
authors.forename: Pascal
authors.initials: P
authors.lastname: Vranckx
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Percoco
authors.forename: Carlo
authors.initials: C
authors.lastname: Tumscitz
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
authors.forename: Federico
authors.initials: F
authors.lastname: Colombo
authors.forename: Matteo
authors.initials: M
authors.lastname: Tebaldi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fucà
authors.forename: Moh'd
authors.initials: M
authors.lastname: Kubbajeh
authors.forename: Elisa
authors.initials: E
authors.lastname: Cangiano
authors.forename: Monica
authors.initials: M
authors.lastname: Minarelli
authors.forename: Antonella
authors.initials: A
authors.lastname: Scalone
authors.forename: Caterina
authors.initials: C
authors.lastname: Cavazza
authors.forename: Alice
authors.initials: A
authors.lastname: Frangione
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.forename: Jlenia
authors.initials: J
authors.lastname: Marchesini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Parrinello
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D002423:Cause of Death; D000077144:Clopidogrel; D023903:Coronary Restenosis / Q000401:mortality / Q000517:prevention & control; D003331:Coronary Vessels / Q000601:surgery*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D017239:Paclitaxel / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012306:Risk; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D013927:Thrombosis / Q000401:mortality / Q000517:prevention & control; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000068338:Everolimus; D000077144:Clopidogrel; C489443:zotarolimus; D013988:Ticlopidine; D017239:Paclitaxel; D001241:Aspirin; D020123:Sirolimus