Effect of over-2-year dual antiplatelet therapy on the rate of major adverse cardiac and cerebral events for everolimus-eluting stent implantation: The landmark analysis from Tokyo-MD PCI registry.
BACKGROUND
Long-term dual antiplatelet therapy (DAPT) for patients treated with coronary stents has been reported to be effective. However the effectiveness of long-term DAPT for everolimus-eluting stent (EES) implanted patients has been controversial. We assessed the major adverse cardiac and cerebral events (MACCE: a composite of death, myocardial infarction, or cerebral arterial disease) in patients free from MACCE during the first 2 years after EES implantation.


RESULTS
A total of 1918 patients who underwent successful percutaneous coronary intervention (PCI) with EES at 22 centers in Japan in 2010-2011 were enrolled, and 742 patients were free from MACCE for 2 years. We divided these MACCE-free patients into two groups: those who received DAPT for >2 years (Over-2-Year DAPT: n=591), and those who received DAPT for ≤2 years (Under-2-Year DAPT: n=151). We performed the landmark analysis that began at 2 years and evaluated at 3 years after PCI about the occurrence of MACCE, major bleeding, stent thrombosis, and restenosis between these groups, both with and without baseline adjustment by propensity score matching (n=145 in both groups).


RESULTS
Fifty MACCE cases were reported (Over-2-Year DAPT, 38; Under-2-Year DAPT, 12), with no significant differences between the 2 groups (log-rank test, p=0.19). Even after baseline adjustment, there were no differences in MACCE occurrence (Over-2-Year DAPT, 8; Under-2-Year DAPT, 11, p=0.19); 15 cases of major bleeding, 5 of restenosis, and 2 of stent thrombosis were observed after 2-years' follow-up, with no statistical differences between the groups, although the event numbers were too low for comparison.


CONCLUSIONS
Continuing DAPT for >2 years did not prevent MACCE in patients free from MACCE during initial 2 years after EES implantation. Few events of major bleeding, stent thrombosis, and restenosis were observed, with no statistical differences.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: daiucvm@tmd.ac.jp.
Daisuke
D
Ueshima
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Takashi
T
Ashikaga
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Shunji
S
Yoshikawa
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Taro
T
Sasaoka
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Yu
Y
Hatano
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Ken
K
Kurihara
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Yasuhiro
Y
Maejima
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Mitsuaki
M
Isobe
D000368:Aged; D000369:Aged, 80 and over; D002539:Cerebral Arterial Diseases / Q000209:etiology; D023903:Coronary Restenosis; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012042:Registries; D014041:Tokyo; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000068338:Everolimus
Drug-eluting stent; Dual antiplatelet therapy; Major adverse cardiac and cerebral events