Are at Least 12 Months of Dual Antiplatelet Therapy Needed for All Patients With Drug-Eluting Stents?

Coronary artery disease (CAD) remains a principal source of morbidity and mortality among adults in both the developed world and the developing world.1 Despite important advances in medical therapy for CAD, revascularization is frequently necessary. Currently, nearly 2 million percutaneous coronary interventions (PCIs) are performed in the United States and Europe, and >90% of them entail the deployment of at least 1 coronary stent.2 The introduction of metallic coronary stents (bare metal stents [BMS]) 2 decades ago resulted in a significant reduction in the immediate and long-term complications of PCI, particularly dissections, abrupt vessel closure, and need for repeat target lesion or target vessel revascularization. Abrupt vessel closure was essentially eliminated by stents.3 The incidence of target lesion and target vessel revascularization was halved from ≈20% to 25% at 1 year to 10% to 15%. Stents became further refined a decade ago by the addition of eluting antiproliferative agents embedded in durable or resorbable biopolymers (drug-eluting stents [DES]).4–6 This innovation further reduced the need for target vessel or target lesion revascularization to the single-digit range.Response by Becker and Helmy on p 2009 The persisting weaknesses of coronary stents, the propensity to provoke stent thrombosis (ST) and late neoatherosclerosis, were not modified by the introduction of DES. In fact, a sentinel report in 2004 indicated that first-generation DES are prone to late (1–12 months) and very late (>12 months) ST because of their inherent delayed endothelialization.7 Intensive research into the causes and predictors of this phenomenon resulted in the current recommendations of the various professional societies to treat patients after DES implantation with 6 to 12 months of dual antiplatelet therapy (DAPT) consisting of aspirin and an ADP (P2Y12) receptor antagonist.This article reviews the evidence supporting the continuation of DAPT for …