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PLoS One. 2018 Nov 26;13(11):e0207386. doi: 10.1371/journal.pone.0207386. eCollection 2018.

Optimal duration of DAPT after second-generation drug-eluting stent in acute coronary syndrome.

Author information

1
Division of Cardiology, Chungju Medical Center, Chungju, South Korea.
2
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea.
3
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
4
Division of Cardiology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea.
5
Division of Cardiology, Seoul National University Hospital School of Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Abstract

BACKGROUND:

We evaluated optimal duration of dual antiplatelet therapy (DAPT) after second-generation drug-eluting stent (DES) implantation in acute coronary syndrome (ACS).

MATERIAL AND METHODS:

From pooled analysis of three randomized clinical trials (EXCELLENT, IVUS-XPL, RESET), a total of 2,216 patient with ACS undergoing second-generation DES implantation were selected. Each study randomized patients to a short-duration DAPT arm (n = 1119; ≤6 months) or a standard-duration DAPT arm (n = 1097; ≥12 months). Two-thirds of patients were male, and their mean age was 63 years. Mean DAPT durations were 164 ±76 and 359 ±68 days, respectively. The primary endpoint was composite of cardiac death, myocardial infarction, stent thrombosis, stroke or major bleeding during the first 12 months after implantation, analyzed according to the intention-to-treat population.

RESULTS:

Demographic characteristics were balanced between groups. Mean DAPT duration was 164 and 359 days, respectively. Primary endpoint occurred in 22 patients with short-DAPT and 21 patients with standard-DAPT (2.0% versus 1.9%; hazard ratio [HR] 1.03; 95% confidence interval [CI] 0.56-1.86; p = 0.94). Landmark analysis after six-months, no significant difference in primary endpoint between short and standard duration DAPT (1.0% versus 0.8%; HR 1.22; 95% CI 0.51-2.95; p = 0.66).

CONCLUSIONS:

Short-duration DAPT (≤6 months) demonstrated a similar incidence of net adverse cardiovascular and clinical events at 12 months after second-generation DES in ACS compared with standard duration DAPT (≥12 months).

CLINICAL TRIAL REGISTRATION:

EXCELLENT (ClinicalTrials.gov, NCT00698607), RESET (ClinicalTrials.gov, NCT01145079), IVUS-XPL (ClinicalTrials.gov, NCT01308281).

PMID:
30475845
PMCID:
PMC6261023
DOI:
10.1371/journal.pone.0207386
[Indexed for MEDLINE]
Free PMC Article

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