Stent Thrombosis in Drug-Eluting or Bare-Metal Stents in Patients Receiving Dual Antiplatelet Therapy.
OBJECTIVE
This study sought to compare rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE) (composite of death, myocardial infarction, or stroke) after coronary stenting with drug-eluting stents (DES) versus bare-metal stents (BMS) in patients who participated in the DAPT (Dual Antiplatelet Therapy) study, an international multicenter randomized trial comparing 30 versus 12 months of dual antiplatelet therapy in subjects undergoing coronary stenting with either DES or BMS.


BACKGROUND
Despite antirestenotic efficacy of coronary DES compared with BMS, the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Many clinicians perceive BMS to be associated with fewer adverse ischemic events and to require shorter-duration dual antiplatelet therapy than DES.


METHODS
Prospective propensity-matched analysis of subjects enrolled into a randomized trial of dual antiplatelet therapy duration was performed. DES- and BMS-treated subjects were propensity-score matched in a many-to-one fashion. The study design was observational for all subjects 0 to 12 months following stenting. A subset of eligible subjects without major ischemic or bleeding events were randomized at 12 months to continued thienopyridine versus placebo; all subjects were followed through 33 months.


RESULTS
Among 10,026 propensity-matched subjects, DES-treated subjects (n = 8,308) had a lower rate of stent thrombosis through 33 months compared with BMS-treated subjects (n = 1,718, 1.7% vs. 2.6%; weighted risk difference -1.1%, p = 0.01) and a noninferior rate of MACCE (11.4% vs. 13.2%, respectively, weighted risk difference -1.8%, p = 0.053, noninferiority p < 0.001).


CONCLUSIONS
DES-treated subjects have long-term rates of stent thrombosis that are lower than BMS-treated subjects. (The Dual Antiplatelet Therapy Study [DAPT study]; NCT00977938).
Christ Hospital Heart and Vascular Center and The Lindner Center for Research and Education, Cincinnati, Ohio.
Dean J
DJ
Kereiakes
Harvard Clinical Research Institute, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts.
Robert W
RW
Yeh
Harvard Clinical Research Institute, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts.
Joseph M
JM
Massaro
Harvard Clinical Research Institute, Boston, Massachusetts.
Priscilla
P
Driscoll-Shempp
Harvard Clinical Research Institute, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Department of Medicine, Cardiology Division, Boston, Massachusetts.
Donald E
DE
Cutlip
Université Paris-Diderot, Paris, France, INSERM U-1148, Paris, France; Hôpital Bichat, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Paris, France; NHLI, Imperial College, Royal Brompton Hospital, London, United Kingdom.
P Gabriel
PG
Steg
Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom.
Anthony H
AH
Gershlick
Vivantes Neukoelln Medical Center, Department of Cardiology, Angiology, Nephrology and Intensive Care Medicine, Berlin, Germany.
Harald
H
Darius
Monash Heart, Monash Health, Monash University, Victoria, Australia.
Ian T
IT
Meredith
Mercy Hospital, Auckland, New Zealand.
John
J
Ormiston
Montreal Heart Institute, Department of Medicine/Division of Interventional Cardiology, Université de Montréal, Department of Medicine, Montreal, Canada.
Jean-François
JF
Tanguay
Bern University Hospital, Department of Cardiology, Bern, Switzerland.
Stephan
S
Windecker
Center for Heart and Vascular Health, Christiana Care, Wilmington, Delaware.
Kirk N
KN
Garratt
Piedmont Heart Institute, Atlanta, Georgia.
David E
DE
Kandzari
Stanford University, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California.
David P
DP
Lee
University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, Ohio.
Daniel I
DI
Simon
Heart Institute, University of Medicine Iuliu Hatieganu, Cluj Napoca, Romania.
Adrian Corneliu
AC
Iancu
Jan Pawel II Hospital Krakow, Krakow, Poland.
Jaroslaw
J
Trebacz
Harvard Clinical Research Institute, Boston, Massachusetts; Brigham and Women's Hospital, Division of Cardiovascular Medicine, Boston, Massachusetts. Electronic address: lmauri1@partners.org.
Laura
L
Mauri
D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D057216:Propensity Score; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals; D010975:Platelet Aggregation Inhibitors
bare-metal stents; drug-eluting stents; dual antiplatelet therapy; stent thrombosis