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Eur Heart J. 2016 Jan 21;37(4):365-74. doi: 10.1093/eurheartj/ehv481. Epub 2015 Sep 12.

Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: the OPTIDUAL randomized trial.

Author information

1
Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, 75013 Paris, France IHU, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France gerard.helft@aphp.fr.
2
DHU FIRE, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France Hôpital Bichat, Assistance Publique Hôpitaux de Paris, INSERM-U1148, Paris, France NHLI, Royal Brompton Hospital, Imperial College, London, UK.
3
Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, 75013 Paris, France.
4
Centre Hospitalier Versailles, Le Chesnay, France.
5
Centre Hospitalier Universitaire Rangueil, Toulouse, France.
6
Espace Médical Mounier, Grenoble, France.
7
Centre Hospitalier Universitaire, Angers, France.
8
Centre Hospitalier Universitaire, Montpellier, France.
9
Centre Hospitalier Universitaire, Rouen, France INSERM U 1096, Rouen, France.
10
Polyclinique de Bergerac, Bergerac, France.
11
Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris 7, Paris, France.
12
Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
13
Hôpital Privé de l'Ouest Parisien, Trappes, France.
14
Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris 6, France.
15
Hôpital Cherbourg, Cherbourg, France.
16
Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, 75013 Paris, France IHU, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France.
17
Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris Pierre et Marie Curie, Paris, France INSERM UMR_S 938, Paris, France.
18
Centre Hospitalier Universitaire Nîmes, Université de Montpellier, Nîmes, France.
19
Centre Hospitalier Universitaire, Bordeaux, France.
20
Unité de Recherche Clinique Lariboisière St Louis Hôpital Fernand Widal, Assistance Publique Hôpitaux de Paris, Université Paris-Diderot, Paris, France.
21
Unité de Recherche Clinique Lariboisière St Louis Hôpital Fernand Widal, Assistance Publique Hôpitaux de Paris, Université Paris-Diderot, Paris, France PARTNERS/F-CRIN, Paris, France.

Abstract

AIM:

This open-label, randomized, and multicentre trial tested the hypothesis that, on a background of aspirin, continuing clopidogrel would be superior to stopping clopidogrel at 12 months following drug-eluting stent (DES) implantation.

METHODS AND RESULTS:

Patients (N = 1799) who had undergone placement of ≥1 DES for stable coronary artery disease or acute coronary syndrome were included in 58 French sites (January 2009-January 2013). Patients (N = 1385) free of major cardiovascular/cerebrovascular events or major bleeding and on aspirin and clopidogrel 12 months after stenting were eligible for randomization (1:1) between continuing clopidogrel 75 mg daily (extended-dual antiplatelet therapy, DAPT, group) or discontinuing clopidogrel (aspirin group). The primary outcome was net adverse clinical events defined as the composite of death, myocardial infarction, stroke, or major bleeding. Follow-up was planned from a minimum of 6 to a maximum of 36 months after randomization. Owing to slow recruitment, the study was stopped after enrolment of 1385 of a planned 1966 patients. Median follow-up after stenting was 33.4 months. The primary outcome occurred in 40 patients (5.8%) in the extended-DAPT group and 52 in the aspirin group (7.5%; hazard ratio 0.75, 95% confidence interval 0.50-1.28; P = 0.17). Rates of death were 2.3% in the extended-DAPT group and 3.5% in the aspirin group (HR 0.65, 95% CI 0.34-1.22; P = 0.18). Rates of major bleeding were identical (2.0%, P = 0.95).

CONCLUSIONS:

Extended DAPT did not achieve superiority in reducing net adverse clinical events compared to 12 months of DAPT after DES placement. The power of the OPTIDUAL trial was however low and reduced by premature termination of enrolment.

CLINICALTRIALSGOV NUMBER:

NCT00822536.

KEYWORDS:

Bleeding; Clopidogrel; Drug-eluting stent; Dual antiplatelet therapy; Myocardial infarction; Randomized trial

PMID:
26364288
DOI:
10.1093/eurheartj/ehv481
[Indexed for MEDLINE]

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