Open AccessClinical Outcome of First‐ vs Second‐Generation DES According to DAPT Duration: Results of ARCTIC ‐Generation
Author(s) -
Collet JeanPhilippe,
Silvain Johanne,
Kerneis Mathieu,
Cuisset Thomas,
Meneveau Nicolas,
Boueri Ziad,
Barthélémy Olivier,
Rangé Grégoire,
Cayla Guillaume,
Belle Eric Van,
Elhadad Simon,
Carrié Didier,
Caussin Christophe,
Rousseau Hélène,
Aubry Pierre,
Monségu Jacques,
Sabouret Pierre,
O'Connor Stephen A.,
Abtan Jérémie,
SaintEtienne Christophe,
Beygui Farzin,
Vicaut Eric,
Montalescot Gilles
Publication year - 2016
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22512
Subject(s) - medicine , hazard ratio , interquartile range , confidence interval , clinical endpoint , myocardial infarction , stent , cardiology , stroke (engine) , aspirin , randomization , surgery , randomized controlled trial , mechanical engineering , engineering
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 .