Highlights
- •We performed analysis of ACS patients receiving DAPT using clopidogrel >6 months vs. ≤6 months.
- •MACCE did not differ between those 2 groups.
- •In our clinical setting of ACS, the optimal duration of DAPT after DES implantation was not longer than 6 months.
Abstract
Background
The optimal duration of dual antiplatelet therapy (DAPT) remains controversial in
patients with acute coronary syndrome (ACS). We sought to compare outcomes after the
implantation of zotarolimus-eluting stent (ZES) between patients with ACS who received
clopidogrel-based DAPT for >6 months and those treated for ≤6 months.
Methods
From a registry of patients treated with ZESs between October 2005 and January 2010,
1740 patients with ACS were selected for the present analysis. Landmark analyses were
performed for ACS patients who were event-free at 6 months follow-up (n = 1674). The primary outcome was a major adverse cardiac and cerebrovascular event (MACCE),
including all-cause death, myocardial infarction (MI), target vessel revascularization
(TVR), stent thrombosis, or stroke. We also performed adjustments for the baseline
characteristics of patients, using their propensity-score matching (n = 469 pairs).
Results
During a median follow-up of 22.5 months, the rate of MACCE was 6.4% in patients with DAPT >6 months (n = 1140) and 4.7% in patients with DAPT ≤6 months (n = 534) (adjusted hazard ratio [HR] 1.05; 95% confidence interval [CI] 0.61–1.82; p = 0.86). After propensity-score matching, DAPT >6 months was not found to be associated with a lower incidence of MACCE compared with
DAPT ≤6 months (adjusted HR 0.80, 95% CI 0.44–1.45, p = 0.46). The rates of all-cause death or MI, TVR, stent thrombosis, and stroke also
did not differ significantly between two groups.
Conclusion
DAPT for >6 months do not seem to be associated with improved clinical outcomes in patients with
ACS undergoing percutaneous coronary intervention (PCI) with ZES.
Abbreviations:
ACS (acute coronary syndrome), CI (confidence interval), DESs (drug-eluting stents), DAPT (dual antiplatelet therapy), HR (hazard ratio), MACCE (major adverse cardiac and cerebrovascular event), MI (myocardial infarction), PCI (percutaneous coronary intervention), TVR (target vessel revascularization), ZES (zotarolimus-eluting stents)Keywords
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Article info
Publication history
Published online: July 04, 2015
Accepted:
June 24,
2015
Received in revised form:
June 20,
2015
Received:
March 2,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
