title: Benefit of long-term dual anti-platelet therapy in patients treated with drug-eluting stents: from the NHLBI dynamic registry.
abstract: The optimal duration of dual-antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is an important, unanswered question. This study was designed to evaluate the association of varying durations of DAPT on clinical outcomes after DES implantation for the treatment of coronary artery disease. Using the National Heart, Lung, and Blood Institute Dynamic Registry, patients enrolled in the last 2 waves after index percutaneous coronary intervention with DES and who were event free at the time of landmark analysis were included. Landmark analysis was performed 12 and 24 months after percutaneous coronary intervention, and patients were stratified according to continued use of DAPT or not. Subjects were evaluated for rates of death, myocardial infarction, and stent thrombosis at 4 years from their index procedures. The numbers of evaluable patients were 2,157 and 1,918 for the 12- and 24-month landmarks, respectively. In both landmark analyses, there was a significantly lower 4-year rate of death or myocardial infarction in the group that continued DAPT compared to the group that did not (12 months: 10.5% vs 14.5%, p = 0.01; 24 months: 5.7% vs 8.6%, p = 0.02). Beneficial differences in the group that continued on DAPT were preserved after multivariate and propensity adjustment. There were no significant differences in definite stent thrombosis in either landmark analysis. In conclusion, at 12 and 24 months after DES implantation, continued use of DAPT was associated with lower 4-year risk for death and myocardial infarction.
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA. mulukutlasr@upmc.edu
authors.forename: Suresh R
authors.initials: SR
authors.lastname: Mulukutla
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.forename: Helen A
authors.initials: HA
authors.lastname: Vlachos
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.forename: Catalin
authors.initials: C
authors.lastname: Toma
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Kip
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holper
authors.forename: Joon S
authors.initials: JS
authors.lastname: Lee
authors.forename: Sameer
authors.initials: S
authors.lastname: Khandhar
authors.forename: Michael
authors.initials: M
authors.lastname: Kutcher
authors.forename: Sheryl
authors.initials: S
authors.lastname: Kelsey
authors.forename: Conrad
authors.initials: C
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Faxon
authors.forename: David O
authors.initials: DO
authors.lastname: Williams
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000494:pharmacology; D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D017239:Paclitaxel / Q000494:pharmacology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D020123:Sirolimus / Q000494:pharmacology; D015996:Survival Rate / Q000639:trends; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D017239:Paclitaxel; D001241:Aspirin; D020123:Sirolimus