title: Clinical Outcome of First- vs Second-Generation DES According to DAPT Duration: Results of ARCTIC-Generation.
abstract: There is an apparent benefit with extension of dual antiplatelet therapy (DAPT) beyond 1 year after implantation of drug-eluting stents (DES). Assessment by a Double Randomization of a Conventional Antiplatelet Strategy vs a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation, and of Treatment Interruption vs Continuation One Year After Stenting (ARCTIC)-Generation assessed whether there is a difference of outcome between first- vs second-generation DES and if there is an interaction with DAPT duration in the ARCTIC-Interruption study. ARCTIC-Interruption randomly allocated 1259 patients 1 year after stent implantation to a strategy of interruption of DAPT (n = 624), in which aspirin antiplatelet treatment only was maintained, or DAPT continuation (n = 635) for 6 to 18 additional months. The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization. A total of 520 and 722 patients received a first- and a second-generation DES, respectively. After a median follow-up of 17 months (interquartile range, 15-18 months) after randomization, the primary endpoint occurred in 32 (6.2%) and 19 (2.6%) patients with first- and second-generation DES, respectively (hazard ratio: 2.31, 95% confidence interval: 1.31-4.07, P = 0.004). This was observed irrespective of the strategy of interruption or continuation of DAPT and timing of study recruitment. Major bleeding events occurred in 4 (0.8%) and 3 patients (0.4%) with first- and second-generation DES, respectively (hazard ratio: 1.79, 95% confidence interval: 0.40-8.02, P = 0.44). Results did not change after multiple adjustments for potential confounding variables. ARCTIC-Generation showed worse clinical outcome with first- vs second-generation DES, a difference that appeared to persist even with prolonged DAPT.
authors.affiliation: Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France.
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.affiliation: Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kerneis
authors.affiliation: Department of Cardiology, CHU La Timone, Marseille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuisset
authors.affiliation: Department of Cardiology, CHU Jean Minjoz, Besançon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.affiliation: Department of Cardiology, CH de Bastia, France.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Boueri
authors.affiliation: Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthélémy
authors.affiliation: Department of Cardiology, Les Hôpitaux de Chartres, Le Coudray, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Rangé
authors.affiliation: ACTION Study Group, Department of Cardiology, CHU Carémeau, Nîmes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.affiliation: Department of Cardiology, Lille University Hospital, Lille, France.
authors.forename: Eric Van
authors.initials: EV
authors.lastname: Belle
authors.affiliation: Department of Cardiology, CH de Lagny-Marne la Vallée, Lagny-sur-Marne, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Elhadad
authors.affiliation: Department of Cardiology, CHU Rangueil, Toulouse, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.affiliation: Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
authors.affiliation: ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), Paris, France.|Université Denis Diderot, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Rousseau
authors.affiliation: Department of Cardiology, Centre Hospitalier Bichat (APHP), Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Aubry
authors.affiliation: Department of cardiology, Groupe Hospitalier Mutualiste, Grenoble, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Monségu
authors.affiliation: Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Sabouret
authors.affiliation: Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: O'Connor
authors.affiliation: Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Abtan
authors.affiliation: Department of Cardiology, CHU Trousseau, Tours, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Saint-Etienne
authors.affiliation: ACTION Study Group, CHU Côte de Nacre, Caen, France.
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.affiliation: ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), Paris, France.|Université Denis Diderot, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.affiliation: Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D005602:France; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors