Clinical outcomes with 6 months dual antiplatelet therapy after implantation of biolimus-A9 drug eluting coronary stents.
BACKGROUND
Duration of dual antiplatelet therapy (DAPT) following drug eluting stent (DES) implantation remains poorly defined. Endothelialisation of biodegradable polymer biolimus-eluting stents occurs early, and 6 months DAPT may be adequate.


OBJECTIVE
We evaluated long term outcome in patients treated with biolimus-eluting stents who were treated with 6 months DAPT. Endpoints included cardiac death and non-fatal stent thrombosis occurring 6 to 12 months after stent implantation.


METHODS
692 patients (77.2% male), aged 65.6 ± 12.5 years received biolimus-eluting DES (March 2008 -November 2011). Vital status was tracked through the Medical Research Information Service. Episodes of non-fatal stent thrombosis, (Academic Research Consortium definition) between months 6 and 12 were tracked via systematic database searches (5 PCI centres).


RESULTS
Presentations included acute coronary syndrome (47.2%) and stable coronary disease (52.8%). Vessels treated included left main stem (6.8%), left anterior descending (37.4%), circumflex (19.1%), right coronary artery (34.5%) and saphenous vein graft (2.1%) respectively. High-risk subsets included diabetes (15.6%); AHA type C lesions (35.1%) and chronic total occlusions (12.8%). During median follow-up of 700 days (0 to 1392) there were 42 deaths (6.1%); 4.2% at 0-6 months, 1.0% at 6-12 months and 0.9% at >12 months. Of the 7 deaths between 6 and 12 months, one death was adjudicated as possible stent thrombosis. There were no cases of non-fatal known stent thrombosis. All cause mortality accrued with smooth decremental incidence. Statistical examination showed no evidence of event clustering between 6 and 12 months.


CONCLUSIONS
After implantation of biodegradable polymer biolimus-eluting coronary stents, 6 months DAPT appears to be adequate, safe and effective.
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK.
James
J
Cockburn
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK.
Nilesh
N
Pareek
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK.
Petra
P
Poliacikova
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK.
Smriti
S
Saraf
Department of Cardiology, Western Sussex Hospital NHS Trust, UK.
Rupert
R
Williams
Department of Cardiology, East Sussex Healthcare NHS Trust, UK.
Gurpreet
G
Dhillon
Department of Mathematics, Sussex University, UK.
Derek
D
Robinson
Department of Cardiology, East Sussex Healthcare NHS Trust, UK.
Robert
R
Gerber
Department of Cardiology, Western Sussex Hospital NHS Trust, UK.
Robert
R
Hatrick
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK.
Lucy
L
Blows
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK.
Adam
A
de Belder
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK. Electronic address: david.hildick-smith@bsuh.nhs.uk.
David
D
Hildick-Smith
D020341:Absorbable Implants / Q000009:adverse effects / Q000706:statistics & numerical data; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000401:mortality / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016019:Survival Analysis; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; C518022:umirolimus; D020123:Sirolimus
Death; Dual anti-platelet; Outcomes; Stent thrombosis