Author + information
- Ajay Kirtane,
- Sigmund Silber,
- Franz–Josef Neumann,
- Patrick Serruys,
- Laura Mauri,
- Ian Meredith,
- Stephan Windecker,
- Jorge Belardi,
- Petr Widimsky,
- Alan Yeung,
- Shigeru Saito and
- Martin Leon
Continuation of dual antiplatelet therapy (DAPT), consisting of aspirin plus a P2Y12 receptor antagonist, is currently recommended for 12 months following drug–eluting stent (DES) implantation. However, observational data suggest that a significant proportion of patients either interrupt or are unable to tolerate DAPT in this period. Whether earlier interruption and/or discontinuation of DAPT is associated with a higher risk of stent thrombosis (ST), particularly with newer generation DES, is not clearly defined.
One–year ST data from 4,930 patients treated with a Resolute™ Zotarolimus–eluting stent (R–ZES) in the global RESOLUTE clinical program were analyzed according to DAPT status. ST was assessed based on the timing of first DAPT interruption (0–3 vs. >3–12 months), and was further categorized by the type of interruption (permanent, interruption >14 days or interruption of >1 to <14 days). Comparison of longer–term outcomes (e.g. for patients on DAPT for 12 months vs longer–term use) is in progress.
The mean patient age was 63.9 years; 30.2% had diabetes and 45.1% presented with an acute coronary syndrome. A total of 1071 (21.7%) patients had an interruption of DAPT during the first year after DES implantation. Among these, 256 (5.2% of the overall study cohort) had a first interruption within 3 months, with 5 ST events (one ARC definite ST and 4 ARC probable ST, 1.95% incidence of ARC definite/probable ST at 1 year). Of patients with DAPT interruption within 0–3 months, all 5 ST events occurred in the group of patients off DAPT for >14 days (n=194, including 119 patients who permanently discontinued DAPT). Notably, among the 815 patients (16.5% of the overall study cohort) with a first interruption beyond 3 months, there were no ST events at 1 year. Comparison of longer–term outcomes (e.g. for patients on DAPT for 12 months vs. longer–term use) will be presented.
A significant proportion of patients interrupted DAPT during the first year after R–ZES implantation. For patients interrupting DAPT after 3 months, the ST rate was very low, underscoring the need for further studies examining the optimal duration of DAPT after DES implantation.
West, Room 2005
Monday, March 11, 2013, 9:15 a.m.–9:25 a.m.
Session Title: Adjunct Pharmacology
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 2909–11
- 2013 American College of Cardiology Foundation