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Long‐term outcomes in patients with acute coronary syndromes related to prolonging dual antiplatelet therapy more than 12 months after coronary stenting
Author(s) -
Wimmer Neil J.,
Dufour Alyssa B.,
Cho Kelly,
Gag David R.,
Quach Lien,
Ly Samantha,
Do JacquelynMy,
Ostrowski Simon,
Michael Gaziano J.,
Faxon David P.,
Kinlay Scott
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26831
Subject(s) - medicine , coronary stenting , acute coronary syndrome , cardiology , platelet aggregation inhibitor , myocardial infarction , aspirin , stent , restenosis
Objectives To assess the impact of stent type on the risk of death or myocardial infarction (MI) related to dual antiplatelet therapy (DAPT) more than 12 months (prolonged DAPT) versus 12 or less months after PCI for an acute coronary syndrome (ACS). Background The recent DAPT study reported lower recurrent ischemic events from prolonged DAPT in patients treated with PCI for an ACS, but was underpowered to determine the impact of stent type. Methods We determined clinical outcomes after PCI for an ACS (median follow‐up: DES = 26 months, BMS = 46 months) in 18,484 patients in the Veterans Affairs system treated with first generation drug‐eluting stents (DES) or bare‐metal stents (BMS). We used landmark analyses starting 1 year after the index PCI to assess the risk of prolonged DAPT on the primary endpoint of death or MI. Multivariable and propensity models adjusted for confounding. Results There was a significant interaction between stent type and prolonged DAPT for death and MI ( P = 0.0036), death ( P = 0.054), and major bleeding ( P = 0.0013). Patients treated with prolonged DAPT had lower risks of death or MI (HR = 0.71, 95% CI = 0.61, 0.82) and death (HR = 0.74, 95%CI = 0.62, 0.89) with DES, but not BMS, and higher risks of major bleeding, particularly with BMS (HR = 1.67, P < 0.001) than DES (HR = 1.24, p = 0.01). Conclusions Prolonging DAPT more than 12 months after PCI for ACS only associated with a lower risk of ischemic events in the 1–4 years after PCI in those receiving first generation DES. Stent type may influence the benefit of prolonged DAPT. © 2016 Wiley Periodicals, Inc.