Author + information
- Robert W. Yeha,b,
- Dean Kereiakesa,b,
- Philippe Stega,b,
- Donald Cutlipa,b,
- Kevin Crocea,b,
- Patricia Apruzzesea,b,
- Joseph Massaroa,b and
- Laura Mauria,b
Background: Extended duration dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) reduces myocardial infarction but increases bleeding. Patients with high risk coronary anatomy may derive greater benefit from prolonged treatment.
Methods: In the DAPT Study, patients surviving one year without a major ischemic or bleeding event after PCI were randomized to continued thienopyridine therapy plus aspirin vs. placebo plus aspirin for an additional 18 months. The randomized treatment effect of continued thienopyridine was compared for patients with vs. without anatomically complex disease, based on the prespecified trial definition.
Results: Among 11554 randomized patients, 3730 (32.3%) were found to have complex coronary anatomy (thrombus-containing lesion 41%, lesion length ≥ 30 mm 30%, bifurcation lesion 19%, vein graft lesion 9%, restenosis of drug-eluting stent 9%, > 2 lesions per vessel 6%, > 2 vessels stented 1%, unprotected left main stent 1%, prior brachytherapy 1%). Patients with or without complex anatomy had consistent reductions in ischemic events (myocardial infarction (MI) or stent thrombosis) and increases in bleeding events. (Table).
Conclusions: In the DAPT Study, the magnitude of reduction in ischemic events with continued thienopyridine was similar in patients with and without protocol-defined complex coronary anatomy. Factors other than coronary anatomy may be more useful in guiding individualized DAPT treatment duration after PCI.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Considerations in Antiplatelet Therapy and in ACS
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1113-131
- 2017 American College of Cardiology Foundation