Abstract 15170: Extended Duration Dual Antiplatelet Therapy After Percutaneous Coronary Intervention Among Patients With Peripheral Arterial Disease: A Sub-Analysis of the Dual Antiplatelet Therapy Study
Introduction: Peripheral arterial disease (PAD) is prevalent among patients undergoing percutaneous coronary intervention (PCI).
Hypotheses: PAD patients have increased coronary ischemic risk after PCI and may experience different ischemic event reduction and bleeding risk with extended dual antiplatelet therapy versus those without PAD.
Methods: The DAPT Study enrolled 25,682 patients following PCI with coronary stenting. After 12 months of thienopyridine plus aspirin, 11,648 were randomized to thienopyridine plus aspirin versus placebo plus aspirin for 18 months. Endpoints included ischemic events (myocardial infarction or definite/probable stent thrombosis) and bleeding (GUSTO moderate or severe).
Results: Of enrolled patients, 1,745 (6.8%) had PAD. PAD patients were older, had more cardiac risk factors including diabetes, hypertension and prior MI, and presented less often with MI at index PCI. Compared with patients without PAD, PAD patients had higher rates of ischemic events (6.2% v 2.7%, p<0.01) and bleeding (5.7% vs 2.5%, p<0.01) within the first 12 months (Figure). Among randomized patients, 649 (5.6%) had PAD. Between 12 and 30 months, PAD patients had greater rates of ischemic events (6.0% vs 2.9%, p<0.01) and bleeding (4.9% vs 1.7%, p<0.01) compared with those without PAD. Of patients with and without PAD, continued thienopyridine versus placebo was associated with consistent reductions in ischemic events (PAD: 4.7% vs 7.3%, HR 0.63, 95%CI 0.32-1.22, p=0.16; no PAD: 2.0% vs 3.8%, HR 0.53, 95%CI 0.42-0.66, p<0.01; interaction p=0.70) and increases in rates of bleeding (PAD: 6.3% vs 3.5%, HR 1.82, 95%CI 0.87-3.83, p=0.11; no PAD: 2.2% vs 1.3%, HR 1.66, 95%CI 1.23–2.24, p<0.01; interaction p=0.28).
Conclusions: PAD patients had more early and late ischemic and bleeding events after PCI than did those without PAD. Extended dual antiplatelet therapy provides consistent ischemic benefit and bleeding risk among patients with and without PAD.
- Peripheral artery disease (PAD)
- Dual antiplatelet
- Coronary interventions
- Myocardial infarction
Author Disclosures: E. Secemsky: None. R. Yeh: Research Grant; Significant; Abiomed, Boston Scientific. Consultant/Advisory Board; Modest; Abbott. Consultant/Advisory Board; Significant; Boston Scientific. D. Kereiakes: Research Grant; Significant; Abbott Vascular, Boston Scientific. Consultant/Advisory Board; Modest; Svelte Medical Systems, Micell Technologies. Consultant/Advisory Board; Significant; Abbott Vascular, Boston Scientific. D.E. Cutlip: Other Research Support; Modest; Boston Scientific, Medtronic, Celonova. P.G. Steg: Research Grant; Significant; Sanofi, Servier, Merck. Consultant/Advisory Board; Modest; Amarin, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CSL-Behring, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Merck, Janssen, Novartis, Pfizer, The Medicines Company, Regeneron, Roche. Consultant/Advisory Board; Significant; AstraZeneca, Sanofi, Servier. J.M. Massaro: None. P.K. Apruzzese: None. L. Mauri: Speakers Bureau; Modest; AstraZeneca, Sanofi, Daiichi Sankyo. Consultant/Advisory Board; Modest; Amgen, St Jude. Other; Modest; Biotronik - Steering Committee, Corvia - Steering Committee, ReCor - Prinicipal Investigator, Boeringher Ingelheim - Coordinating Investigator.
- © 2016 by American Heart Association, Inc.