Abstract 14867: Duration of Dual Antiplatelet Therapy After Various Drug Eluting Stent Implantation
Objective: To evaluate efficacy and safety of long duration DAPT i.e., > 12 months (L-DAPT) and short duration DAPT i.e., ≤ 12 months (S-DAPT) after various drug eluting stent (DES) implantation.
Methods: We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) assessing the effect of L-DAPT versus S-DAPT after sirolimus-eluting (Cypher®); paclitaxel-eluting stents (Taxus®); zotarolimus-eluting (Endeavor®) and everolimus-eluting stents (Xience V®) implantation. Primary efficacy end points were stent thrombosis, target vessel revascularization (TVR), all cause mortality and cardiac mortality. Primary safety end points were major bleeding and stroke. Event rates were compared using a Forest plot of relative risk using a random effects model.
Results: We included six RCTs that randomized 19,012 patients to S-DAPT versus L- DAPT (4638 first generation DES; 14,374 in second generation DES; 8099 EES; 4876 in ZES). Outcomes with S-DAPT and L-DAPT in various generations of DES stents are summarized in table below:
Conclusion: Compared with L-DAPT, S-DAPT was associated with higher rate of myocardial infarction and stent thrombosis without any significant difference in the rate of all cause mortality, cardiac mortality and stroke after first and second generation DES. However, on subgroup analysis of second generation stent there was no significant difference in the rate of all cause mortality, cardiac mortality, myocardial infarction, stent thrombosis and stroke with S-DAPT and L-DAPT after ZES implantation. Shorter duration DAPT may be optimum for newer generation stents particularly ZES.
- drug eluting stent
- dual antiplatelet therapy
- zotarolimus-eluting stent
- paclitaxel-eluting stents
- everolimus-eluting stents
Author Disclosures: A. Sharma: None. S.K. Sharma: None. A. Garg: None. A. Vallakati: None. G. Stone: None. D. Mukherjee: None. C. Lavie: None. J.D. Marmur: None.
- © 2015 by American Heart Association, Inc.