title: Long-term outcomes in patients with acute coronary syndromes related to prolonging dual antiplatelet therapy more than 12 months after coronary stenting.
abstract: OBJECTIVE
  To assess the impact of stent type on the risk of death or myocardial infarction (MI) related to dual antiplatelet therapy (DAPT) more than 12 months (prolonged DAPT) versus 12 or less months after PCI for an acute coronary syndrome (ACS).
  
  
  BACKGROUND
  The recent DAPT study reported lower recurrent ischemic events from prolonged DAPT in patients treated with PCI for an ACS, but was underpowered to determine the impact of stent type.
  
  
  METHODS
  We determined clinical outcomes after PCI for an ACS (median follow-up: DES = 26 months, BMS = 46 months) in 18,484 patients in the Veterans Affairs system treated with first generation drug-eluting stents (DES) or bare-metal stents (BMS). We used landmark analyses starting 1 year after the index PCI to assess the risk of prolonged DAPT on the primary endpoint of death or MI. Multivariable and propensity models adjusted for confounding.
  
  
  RESULTS
  There was a significant interaction between stent type and prolonged DAPT for death and MI (P = 0.0036), death (P = 0.054), and major bleeding (P = 0.0013). Patients treated with prolonged DAPT had lower risks of death or MI (HR = 0.71, 95% CI = 0.61, 0.82) and death (HR = 0.74, 95%CI = 0.62, 0.89) with DES, but not BMS, and higher risks of major bleeding, particularly with BMS (HR = 1.67, P < 0.001) than DES (HR = 1.24, p = 0.01).
  
  
  CONCLUSIONS
  Prolonging DAPT more than 12 months after PCI for ACS only associated with a lower risk of ischemic events in the 1-4 years after PCI in those receiving first generation DES. Stent type may influence the benefit of prolonged DAPT. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Cardiovascular Division, VA Boston Healthcare System, Boston, Massachusetts.|Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Wimmer
authors.affiliation: MAVERIC, VA Boston Healthcare System, Boston, Massachusetts.|Harvard Medical School, Department of Medicine, Boston, Massachusetts.|Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Dufour
authors.affiliation: MAVERIC, VA Boston Healthcare System, Boston, Massachusetts.|Harvard Medical School, Department of Medicine, Boston, Massachusetts.|Division of Ageing, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Kelly
authors.initials: K
authors.lastname: Cho
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.|MAVERIC, VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: David R
authors.initials: DR
authors.lastname: Gagnon
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.|MAVERIC, VA Boston Healthcare System, Boston, Massachusetts.|University of Massachusetts, Department of Gerontology, Boston, Massachusetts.
authors.forename: Lien
authors.initials: L
authors.lastname: Quach
authors.affiliation: Cardiovascular Division, VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Samantha
authors.initials: S
authors.lastname: Ly
authors.affiliation: Cardiovascular Division, VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Jacquelyn-My
authors.initials: JM
authors.lastname: Do
authors.affiliation: Cardiovascular Division, VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Simon
authors.initials: S
authors.lastname: Ostrowski
authors.affiliation: Cardiovascular Division, VA Boston Healthcare System, Boston, Massachusetts.|Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.|MAVERIC, VA Boston Healthcare System, Boston, Massachusetts.|Harvard Medical School, Department of Medicine, Boston, Massachusetts.
authors.forename: J
authors.initials: J
authors.lastname: Michael Gaziano
authors.affiliation: Cardiovascular Division, VA Boston Healthcare System, Boston, Massachusetts.|Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.|Harvard Medical School, Department of Medicine, Boston, Massachusetts.
authors.forename: David P
authors.initials: DP
authors.lastname: Faxon
authors.affiliation: Cardiovascular Division, VA Boston Healthcare System, Boston, Massachusetts.|Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.|Harvard Medical School, Department of Medicine, Boston, Massachusetts.
authors.forename: Scott
authors.initials: S
authors.lastname: Kinlay
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D000077144:Clopidogrel; D016208:Databases, Factual; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; 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; D057216:Propensity Score; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: bare metal; drug-eluting; dual antiplatelet; duration; outcomes