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Clin Cardiol. 2016 Apr;39(4):192-200. doi: 10.1002/clc.22512. Epub 2016 Feb 16.

Clinical Outcome of First- vs Second-Generation DES According to DAPT Duration: Results of ARCTIC-Generation.

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Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France.
Department of Cardiology, CHU La Timone, Marseille, France.
Department of Cardiology, CHU Jean Minjoz, Besançon, France.
Department of Cardiology, CH de Bastia, France.
Department of Cardiology, Les Hôpitaux de Chartres, Le Coudray, France.
ACTION Study Group, Department of Cardiology, CHU Carémeau, Nîmes, France.
Department of Cardiology, Lille University Hospital, Lille, France.
Department of Cardiology, CH de Lagny-Marne la Vallée, Lagny-sur-Marne, France.
Department of Cardiology, CHU Rangueil, Toulouse, France.
Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.
ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), Paris, France.
Université Denis Diderot, Paris, France.
Department of Cardiology, Centre Hospitalier Bichat (APHP), Paris, France.
Department of cardiology, Groupe Hospitalier Mutualiste, Grenoble, France.
Department of Cardiology, CHU Trousseau, Tours, France.
ACTION Study Group, CHU Côte de Nacre, Caen, France.


There is an apparent benefit with extension of dual antiplatelet therapy (DAPT) beyond 1 year after implantation of drug-eluting stents (DES). Assessment by a Double Randomization of a Conventional Antiplatelet Strategy vs a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation, and of Treatment Interruption vs Continuation One Year After Stenting (ARCTIC)-Generation assessed whether there is a difference of outcome between first- vs second-generation DES and if there is an interaction with DAPT duration in the ARCTIC-Interruption study. ARCTIC-Interruption randomly allocated 1259 patients 1 year after stent implantation to a strategy of interruption of DAPT (n = 624), in which aspirin antiplatelet treatment only was maintained, or DAPT continuation (n = 635) for 6 to 18 additional months. The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization. A total of 520 and 722 patients received a first- and a second-generation DES, respectively. After a median follow-up of 17 months (interquartile range, 15-18 months) after randomization, the primary endpoint occurred in 32 (6.2%) and 19 (2.6%) patients with first- and second-generation DES, respectively (hazard ratio: 2.31, 95% confidence interval: 1.31-4.07, P = 0.004). This was observed irrespective of the strategy of interruption or continuation of DAPT and timing of study recruitment. Major bleeding events occurred in 4 (0.8%) and 3 patients (0.4%) with first- and second-generation DES, respectively (hazard ratio: 1.79, 95% confidence interval: 0.40-8.02, P = 0.44). Results did not change after multiple adjustments for potential confounding variables. ARCTIC-Generation showed worse clinical outcome with first- vs second-generation DES, a difference that appeared to persist even with prolonged DAPT.

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